Value of endoscopic ultrasound in the selection of early gastric cancer invasion depth and guiding treatment methods
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摘要:
目的探讨内镜超声对早期胃癌浸润深度及指导治疗方法选择中的应用价值。 方法选取2019年1月~2020年8月在我院接受内镜超声检查的早期胃癌患者作为观察组（n=80），同时选取未接受内镜超声检查的早期胃癌患者作为对照组（n=60），比较内镜超声与病理结果情况，分析内镜超声诊断Tis/T1a、T1b的价值，比较观察组和对照组治愈性切除比例的差异。 结果观察组Tis/T1a、T1b比例分别为86.23%和13.75%，与对照组差异无统计学意义（P>0.05）；内镜超声与病理结果一致性Kappa值为0.634（P < 0.05），内镜超声诊断准确率为90.00%，其中有2例T1b误诊为Tis/T1a，有6例Tis/T1a误诊为T1b，内镜超声诊断Tis/T1a的灵敏性、特异性、阳性预测值和阴性预测值分别为91.30%、81.82%、96.92%和60.00%；内镜超声诊断T1b的灵敏性、特异性、阳性预测值和阴性预测值分别为81.82%、91.30%、60.00%和96.92%；观察组治愈性切除比例高于对照组，差异有统计学意义（P < 0.05）。 结论内镜超声在早期胃癌浸润深度诊断中有较高的价值，有助于指导医师对切除范围的了解，提高治疗效果。 Abstract:ObjectiveTo investigate the application value of endoscopic ultrasonography in the depth of invasion and treatment of early gastric cancer. MethodsEighty patients with early gastric cancer who underwent endoscopic ultrasonography in our hospital from January 2019 to August 2020 were selected as the observation group, and 60 patients with early gastric cancer who did not receive endoscopic ultrasonography were selected as control group. The results of endoscopic ultrasonography and pathology were compared, the value of endoscopic ultrasonography in the diagnosis of tis/T1a and T1b were analyzed. And the difference of curative incision were compared between the observation group and the control group. ResultsThe ratio of tis/T1a and T1b in the observation group was 86.23% and 13.75%, respectively. Comparing with the control group, the difference was not statistically significant (P>0.05). The Kappa value of endoscopic ultrasonography consistent with the pathologic results was 0.634 (P < 0.05); The diagnostic accuracy of endoscopic ultrasonography was 90.00%, among which 2 cases of T1b were misdiagnosed as Tis/T1a and 6 cases of Tis/T1a were misdiagnosed as T1b. The sensitivity, specificity, positive predictive value and negative predictive value of endoscopic ultrasonography in Tis/T1a diagnosis were 91.30%, 81.82%, 96.92% and 60.00%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of endoscopic ultrasonography in T1b diagnosis were 81.82%, 91.30%, 60.00% and 96.92%, respectively. The curative resection ratio in the observation group was significantly higher than that in the control group (P < 0.05). ConclusionEndoscopic ultrasonography is of great value in the diagnosis of invasion depth of early gastric cancer, which is helpful to guide doctors to understand the scope of resection and improve the therapeutic effect. -
Key words:
- endoscopic ultrasonography /
- early gastric cancer /
- depth of invasion /
- treatment /
- application value
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图 1 患者男，77岁，超声内镜及胃镜影像表现
A~B: 超声内镜下提示胃窦对应病灶见黏膜层呈低回声增厚, 黏膜下层, 固有肌层, 外膜层显影清 晰, 连续; C~D: 普通胃镜下提示胃窦小弯侧近幽门处可见一大小约1.5 cm IIa+IIc型病灶, 表面可见糜烂.
Figure 1. Endoscopic ultrasound and gastroscope image of a 77-year-old male patient.
表 1 两组患者一般资料比较[n(%)]
Table 1. Comparison of general data between the two groups
组別 男/女 年龄(岁，Mean±SD) 病变部位 内镜分型 上1/3 中1/3 下1/3 隆起型 平坦型 凹陷型 观察组(n=80) 51/29 56.60±4.93 2(26.25) 33(41.25) 26(32.50) 18(22.50) 39(48.75) 23(28.75) 对照组(n=60) 32/18 55.12±5.03 17(28.33) 28(46.67) 15(25.00) 16(26.67) 30(50.00) 14(23.33) t/χ2 0.001 1.743 0.944 0.637 p 0.977 0.084 0.624 0.727 
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表 2 两组病理浸润深度情况比较[n(%)]
Table 2. Comparison of pathological infiltration depth between the two groups
组別 Tis/T1a T1b 观察组(n=80) 69(86.25) 1(13.75) 对照组(n=60) 48(80.00) 12(20.00) χ2 0.975 P 0.323
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表 3 内镜超声与病理结果比较（n）
Table 3. Comparison of endoscopic ultrasonography and pathological results
内镜超声 病理 Kappa P Tis/T1a T1b Tis/T1a 63 2 0.634 0.000 T1b 6 9
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表 4 两组治愈性切除比较[n(%)]
Table 4. Comparison of curative resection between the two groups
组別 治愈性切除 χ2 P 观察组(n=80) 7(88.75) 22.118 0.000 对照组(n=60) 32(53.33)
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