• 吉林大學(xué)中日聯(lián)誼醫(yī)院胃腸外科（長春 130033）;

目的  探討64排增強CT（MDCT）對進展期胃癌（AGC）手術(shù)根治程度的判斷價值。
方法  分析70例AGC患者MDCT增強掃描的影像學(xué)資料，判斷N2（第7、8和9組）淋巴結(jié)轉(zhuǎn)移及臟器受侵情況，并將CT判斷結(jié)果與手術(shù)后病理結(jié)果進行比較。
結(jié)果  62例患者接受手術(shù)治療，8例因手術(shù)禁忌證無法行手術(shù)治療。MDCT術(shù)前判定N2淋巴結(jié)轉(zhuǎn)移的敏感性為92.0%(46/50)，特異性為75.0%(9/12)，準確性為88.7%(55/62)。MDCT術(shù)前判定存在N2或以上淋巴結(jié)轉(zhuǎn)移者81.6%（40/49）行D2以上擴大根治術(shù); 判定N2淋巴結(jié)無轉(zhuǎn)移者92.3%(12/13)行標準D2根治術(shù)。
結(jié)論  MDCT對診斷AGC N2淋巴結(jié)轉(zhuǎn)移及周圍臟器侵犯有重要價值，對AGC手術(shù)根治程度的判定有指導(dǎo)作用。

引用本文： 蘇妍卓,孫立波,舒振波,丁大勇,鄭澤霖. 64排增強CT對進展期胃癌根治程度的判斷價值. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(1): 25-28. doi: 復(fù)制

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1. Park JM, Kim YH. Current approaches to gastric cancer in Korea [J]. Gastrointest Cancer Res, 2008; 2(3): 137144.
2. Díaz de Liao A, Yarnoz C, Aguilar R, et al. Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer [J]. Gastric Cancer, 2008; 11(2): 96102.
3. 季加孚. 胃癌治療的現(xiàn)狀與趨勢 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(1): 13.
4. 朱正綱. 胃癌外科治療相關(guān)問題的基本認識 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1): 13.
5. Kunisaki C, Akiyama H, Nomura M, et al. Comparison of surgical results of D2 versus D3 gastrectomy (paraaortic lymph node dissection) for advanced gastric carcinoma: A multiinstitutional study [J]. Ann Surg Oncol, 2006; 13(7): 659667.
6. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended paraaortic lymphadenectomyJapan Clinical Oncology Group study 9501 [J]. J Clin Oncol, 2004; 22(14): 27672773.
7. Ueda Y, Fujimura T, Kinami S, et al. A randomized phase Ⅲ trial of postoperative adjuvant therapy with S1 alone versus S1 plus PSK for stage Ⅱ/ⅢA gastric cancer: HokurikuKinki ImmunochemoTherapy Study GroupGastric Cancer (HKITGC) [J]. Jpn J Clin Oncol, 2006; 36(8): 519522.
8. Ajani JA, Moiseyenko VM, Tjulandin S, et al. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase Ⅲ trial of advanced gastric or gastroesophageal cancer adenocarcinoma: the V325 Study Group [J]. J Clin Oncol， 2007; 25(22): 32053209.
9. Bouché O, Ychou M, Burtin P, Bedenne L, et al. Adjuvant chemotherapy with 5fluorouracil and cisplatin compared with surgery alone for gastric cancer: 7year results of the FFCD randomized phase Ⅲ trial (8801) [J]. Ann Oncol, 2005; 16(9): 14881497.
10. Habermann CR,Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US [J]. Radiology, 2004; 230(2): 465471.
11. Kim HS, Han HY, Choi JA, et al. Preoperative evaluation of gastric cancer:value of spiral CT during gastric arteriography (CTGA) [J]. Abdom Imaging, 2001; 26(2): 123130.
12. 黃娟, 潘彥辰, 周翔平, 等. 16 排螺旋CT 胃癌診斷和CTTNM 分期的價值 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6): 717721.
13. 姚學(xué)清, 林鋒, 張忠林, 等. 64排CT三維血管重建術(shù)前對胃癌血管侵犯的評估 [J]. 中華胃腸外科雜志, 2008; 11(5): 440443.
14. Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging [J]. Abdom Imaging, 2005; 30(4): 465472.
15. BaSsalamah A, Prokop M, Uffmann M, et al. Dedicated multidetector CT of the stomach: spectrum of diseases [J]. Radiographics, 2003; 23(3): 625644.
16. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with paraaortic nodal dissection for gastric cancer [J]. N Engl J Med, 2008; 359(5): 453462.
17. Yang SH, Zhang YC, Yang KH, et al. An evidencebased medicine review of lymphadenectomy extent for gastric cancer [J]. Am J Surg, 2009; 197(2): 246251.
18. Nobuoka D, Gotohda N, Konishi M,et al. Prevention of postoperative pancreatic fistula after total gastrectomy [J]. World J Surg, 2008; 32(10): 22612266.
19. Piso P, Bellin T, Aselmann H, et al. Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma [J]. Dig Surg, 2002; 19(4): 281285.
20. Okabayashi T, Kobayashi M, Sugimoto T, et al. Postoperative pancreatic fistula following surgery for gastric and pancreatic neoplasm; is distal pancreaticosplenectomy truly safe? [J]. Hepatogastroenterology, 2005; 52(61): 233236.
21. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006; 10(1): 132137.
22. Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreratic lymph nodes [J]. Anticancer Res, 2002; 22(6B): 35133517.
23. 黃子星， 陳心足， 宋彬， 等. 64排螺旋CT對Ⅳ期胃癌術(shù)前分期的價值 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 8(15): 623627.
24. Yang DM, Kim HC, Jin W, et al. 64 multidetectorrow computed tomography for preoperative evaluation of gastric cancer: histological correlation [J]. J Comput Assist Tomogr, 2007; 31(1): 98103.
25. Lee SM, Kim SH, Lee JM, et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer [J]. Abdom Imaging, 2009; 34(4): 430440.
26. Gong JS, Zuo M, Yang P, et al. Value of CT in the diagnosis and followup of gastrointestinal stromal tumors [J]. Clin Imaging, 2008; 32(3): 172177.
  1. 1. Park JM, Kim YH. Current approaches to gastric cancer in Korea [J]. Gastrointest Cancer Res, 2008; 2(3): 137144.
  2. 2. Díaz de Liao A, Yarnoz C, Aguilar R, et al. Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer [J]. Gastric Cancer, 2008; 11(2): 96102.
  3. 3. 季加孚. 胃癌治療的現(xiàn)狀與趨勢 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(1): 13.
  4. 4. 朱正綱. 胃癌外科治療相關(guān)問題的基本認識 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1): 13.
  5. 5. Kunisaki C, Akiyama H, Nomura M, et al. Comparison of surgical results of D2 versus D3 gastrectomy (paraaortic lymph node dissection) for advanced gastric carcinoma: A multiinstitutional study [J]. Ann Surg Oncol, 2006; 13(7): 659667.
  6. 6. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended paraaortic lymphadenectomyJapan Clinical Oncology Group study 9501 [J]. J Clin Oncol, 2004; 22(14): 27672773.
  7. 7. Ueda Y, Fujimura T, Kinami S, et al. A randomized phase Ⅲ trial of postoperative adjuvant therapy with S1 alone versus S1 plus PSK for stage Ⅱ/ⅢA gastric cancer: HokurikuKinki ImmunochemoTherapy Study GroupGastric Cancer (HKITGC) [J]. Jpn J Clin Oncol, 2006; 36(8): 519522.
  8. 8. Ajani JA, Moiseyenko VM, Tjulandin S, et al. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase Ⅲ trial of advanced gastric or gastroesophageal cancer adenocarcinoma: the V325 Study Group [J]. J Clin Oncol， 2007; 25(22): 32053209.
  9. 9. Bouché O, Ychou M, Burtin P, Bedenne L, et al. Adjuvant chemotherapy with 5fluorouracil and cisplatin compared with surgery alone for gastric cancer: 7year results of the FFCD randomized phase Ⅲ trial (8801) [J]. Ann Oncol, 2005; 16(9): 14881497.
  10. 10. Habermann CR,Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US [J]. Radiology, 2004; 230(2): 465471.
  11. 11. Kim HS, Han HY, Choi JA, et al. Preoperative evaluation of gastric cancer:value of spiral CT during gastric arteriography (CTGA) [J]. Abdom Imaging, 2001; 26(2): 123130.
  12. 12. 黃娟, 潘彥辰, 周翔平, 等. 16 排螺旋CT 胃癌診斷和CTTNM 分期的價值 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6): 717721.
  13. 13. 姚學(xué)清, 林鋒, 張忠林, 等. 64排CT三維血管重建術(shù)前對胃癌血管侵犯的評估 [J]. 中華胃腸外科雜志, 2008; 11(5): 440443.
  14. 14. Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging [J]. Abdom Imaging, 2005; 30(4): 465472.
  15. 15. BaSsalamah A, Prokop M, Uffmann M, et al. Dedicated multidetector CT of the stomach: spectrum of diseases [J]. Radiographics, 2003; 23(3): 625644.
  16. 16. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with paraaortic nodal dissection for gastric cancer [J]. N Engl J Med, 2008; 359(5): 453462.
  17. 17. Yang SH, Zhang YC, Yang KH, et al. An evidencebased medicine review of lymphadenectomy extent for gastric cancer [J]. Am J Surg, 2009; 197(2): 246251.
  18. 18. Nobuoka D, Gotohda N, Konishi M,et al. Prevention of postoperative pancreatic fistula after total gastrectomy [J]. World J Surg, 2008; 32(10): 22612266.
  19. 19. Piso P, Bellin T, Aselmann H, et al. Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma [J]. Dig Surg, 2002; 19(4): 281285.
  20. 20. Okabayashi T, Kobayashi M, Sugimoto T, et al. Postoperative pancreatic fistula following surgery for gastric and pancreatic neoplasm; is distal pancreaticosplenectomy truly safe? [J]. Hepatogastroenterology, 2005; 52(61): 233236.
  21. 21. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006; 10(1): 132137.
  22. 22. Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreratic lymph nodes [J]. Anticancer Res, 2002; 22(6B): 35133517.
  23. 23. 黃子星， 陳心足， 宋彬， 等. 64排螺旋CT對Ⅳ期胃癌術(shù)前分期的價值 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 8(15): 623627.
  24. 24. Yang DM, Kim HC, Jin W, et al. 64 multidetectorrow computed tomography for preoperative evaluation of gastric cancer: histological correlation [J]. J Comput Assist Tomogr, 2007; 31(1): 98103.
  25. 25. Lee SM, Kim SH, Lee JM, et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer [J]. Abdom Imaging, 2009; 34(4): 430440.
  26. 26. Gong JS, Zuo M, Yang P, et al. Value of CT in the diagnosis and followup of gastrointestinal stromal tumors [J]. Clin Imaging, 2008; 32(3): 172177.