术前小探头超声内镜检查在早期胃癌治疗方式选择中的作用*

Effects of mini-probe endoscopic ultrasonography for therapeutic decision-making in early gastric cancer prior to operation*

摘要:

目的  评价小探头超声内镜（EUS）在早期胃癌（EGC）治疗方式选择中的作用。方法  回顾性分析2011年1月-2013年12月北京大学肿瘤医院151例单发EGC临床病理资料。分析EUS判断EGC浸润深度的准确率及影响因素，评价基于EUS选择EGC治疗方法的策略。结果  EUS对EGC浸润深度判断的准确率为74.8%。多因素分析结果显示，肿瘤直径>2 cm、内镜下溃疡形成及病灶位于胃中上2/3是导致分期错误的危险因素（P <0.05）。75.3%（107/142）的EGC病例通过基于EUS评估获得了适合的治疗。结论  小探头EUS在EGC浸润深度评估及治疗方式选择中具有良好实用性，当病灶直径大于2 cm、合并溃疡形成或位于胃中上部时，应当谨慎对待EUS结果。

Abstract:

Objective To evaluate the clinical value of mini-probe endoscopic ultrasonography (EUS) in determining the therapeutic strategy for early gastric cancer (EGC) before surgery. Methods 151 EGC lesions were enrolled in the study. The accuracy of EUS-determined depths were compared with histopathologic results, and the effects of EUS-based therapeutic decision-making plan was evaluated. Results The overall accuracy of EUS-determined T staging was 74.8 %. Multivariate analysis revealed that tumor size larger than 2 cm, endoscopic ulceration and tumor located at upper two thirds of the stomach were associated with EUS misdiagnosis (P < 0.05). 75.3 % (107/142) of the EGC patients received proper treatment according to EUS-based therapeutic selection. Conclusions Mini-probe EUS is a useful utility in T-staging and therapeutic strategy selection for EGC. Special attention should be paid when tumor diameter exceeds 2 cm, co-existence of ulcer or tumor located in the upper two-thirds portion of the stomach.