多層螺旋CT血管造影在胃癌規范性根治術術前評估中的價值_《中國普外基礎與臨床雜志》

作者：

劉超 , 黃源 , 林進令

廣西醫科大學第一附屬醫院胃腸外科(廣西南寧 530021);

關鍵詞：

多層螺旋CT血管造影胃癌根治術 TNM分期

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目的探討多層螺旋CT血管造影(multislice spiral computed tomography angiography，MSCTA)在胃癌規范性根治術術前評估中的價值。方法通過術前MSCTA了解86例胃癌患者腹腔干三大動脈分支及其屬支(肝總動脈、肝右動脈、肝左動脈、脾動脈、胃左動脈)的解剖走行情況，并經術中驗證; 同時采用MSCTA對胃癌進行術前TNM分期，并將其與手術后病理結果進行對照。結果通過術中探查驗證，86例患者術前MSCTA評估腹腔干三大動脈分支及其屬支走行情況的準確率為100%。肝動脈解剖異常者22例，變異率為25.58%，其中異常肝右動脈11例(12.79%)、異常肝左動脈7例(8.14%)、同時存在異常肝左及異常肝右動脈1例(1.16%)、肝總動脈源自腸系膜上動脈3例(3.49%)。脾動脈直型24例(27.91%)，輕曲型44例(51.16%)，顯著曲型18例(20.93%)。本組未發現胃左動脈變異情況。通過與術后病理對照，MSCTA對胃癌術前T、N、M分期的準確率分別為75.58%(65/86)、74.42%(64/86)和91.86%(79/86)。結論MSCTA能較客觀地評估胃癌患者術前腹腔干三大動脈分支及其屬支的解剖走行情況及較為準確地進行胃癌術前TNM分期，在制定手術方案、防止術中動脈損傷等方面有著重要的作用。

引用本文： 劉超,黃源,林進令. 多層螺旋CT血管造影在胃癌規范性根治術術前評估中的價值. 中國普外基礎與臨床雜志, 2011, 18(4): 441-445. doi: 復制

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14.	Napieralski R, Ott K, Kremer M, et al. Methylation of tumorrelated genes in neoadjuvanttreated gastric cancer: relation to therapy response and clinicopathologic and molecular features [J]. Clin Cancer Res, 2007, 13(17): 50955102.
15.	Roth AD, Fazio N, Stupp R, et al. Docetaxel, cisplatin, and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase Ⅱ trial of the Swiss Group for Clinical Cancer Research [J]. J Clin Oncol, 2007, 5(22): 32173223.
16.	Lee IJ, Lee JM, Kim SH, et al. Helical CT evaluation of the preoperative staging of gastric cancer in the remnant stomach [J]. AJR Am J Roentgenol, 2009, 192(4): 902908.
17.	Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging [J]. Abdom Imaging, 2005, 30(4): 465472.
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21.	高劍波, 郭華, 楊學華, 等. 胃癌TNM分期螺旋CT與病理學的對照研究 [J]. 腹部影像學, 2006, 21(11): 11551158.
22.	Wei WZ, Yu JP, Li J, et al. Evaluation of contrastenhanced helical hydroCT in staging gastric cancer [J]. World J Gastroenterol, 2005, 11(29): 45924595.
23.	Bhandari S, Shim CS, Kim JH, et al. Usefulness of threedimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology [J]. Gastrointest Endosc, 2004, 59(6): 619626.
24.	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.

1. Sun Z, Xu HM. Stage and microscopic positive margins in the treatment of patients with gastric cancer [J]. Ann Surg Oncol, 2010, 17(3): 943945.
2. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1 000 cases [J]. Ann Surg, 1994, 220(1): 5052.
3. Michels MA. Blood supply and anatomy of the upper abdominal organs [J]. Proc R Soc Med, 1956, 49(9): 683.
4. Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual (7th ed) [M]. New York, NY: Springer, 2010: 113.
5. D’Elia F, Zingarelli A, Palli D, et al. Hydrodynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases [J]. Eur Radiol, 2000, 10(12): 18771885.
6. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation [J]. Am J Surg, 1966, 112(3): 337347.
7. Chen CY, Lee RC, Tseng HS, et al. Normal and variant anatomy of hepatic arteries: angiographic experience [J]. Zhonghua Yi Xue Za Zhi (Taipei), 1998, 61(1): 1723.
8. Winter TC 3rd, Freeny PC, Nghiem HV, et al. Hepatic arterial anatomy in transplantation candidates: evaluation with threedimensional CT arteriography [J]. Radiology, 1995, 95(2): 363370.
9. Weszelits V, Doros A, Puhl M, et al. 3D CT angiography in patients before and after liver transplantation [J]. Transplant Proc, 2001, 33(12): 13721376.
10. Stemmler BJ, Paulson EK, Thornton FJ, et al. Dualphase 3D MDCT angiography for evaluation of the liver before hepatic resection [J]. AJR Am J Roentgenol, 2004, 183(6): 15511557.
11. 葉啟發. 肝動脈變異與肝移植的關系 [J]. 中國現代手術學雜志, 2006, 10(6): 401403.
12. Laghi A, Catalano C, Iannaccone R, et al. Multislice spiral CT angiography in the evaluation of the anatomy of splanchnic vessels: preliminary experience [J]. Radiol Med, 2001, 102(3): 127131.
13. Chang L, Babineau TJ. Simulation training for surgical residents: cool computers or core curriculum? [J]. Curr Surg, 2006, 63(1): 48.
14. Napieralski R, Ott K, Kremer M, et al. Methylation of tumorrelated genes in neoadjuvanttreated gastric cancer: relation to therapy response and clinicopathologic and molecular features [J]. Clin Cancer Res, 2007, 13(17): 50955102.
15. Roth AD, Fazio N, Stupp R, et al. Docetaxel, cisplatin, and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase Ⅱ trial of the Swiss Group for Clinical Cancer Research [J]. J Clin Oncol, 2007, 5(22): 32173223.
16. Lee IJ, Lee JM, Kim SH, et al. Helical CT evaluation of the preoperative staging of gastric cancer in the remnant stomach [J]. AJR Am J Roentgenol, 2009, 192(4): 902908.
17. Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging [J]. Abdom Imaging, 2005, 30(4): 465472.
18. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review [J]. J Clin Oncol, 2007, 25(15): 21072116.
19. 黃子星, 陳心足, 宋彬, 等. 64排螺旋CT對Ⅳ期胃癌術前分期的價值 [J]. 中國普外基礎與臨床雜志, 2008, 15(8): 623627.
20. 曲寧, 羅婭紅. 多層螺旋CT在胃癌TNM分期中的診斷價值 [J]. 實用腫瘤學雜志, 2007, 21(6): 551554.
21. 高劍波, 郭華, 楊學華, 等. 胃癌TNM分期螺旋CT與病理學的對照研究 [J]. 腹部影像學, 2006, 21(11): 11551158.
22. Wei WZ, Yu JP, Li J, et al. Evaluation of contrastenhanced helical hydroCT in staging gastric cancer [J]. World J Gastroenterol, 2005, 11(29): 45924595.
23. Bhandari S, Shim CS, Kim JH, et al. Usefulness of threedimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology [J]. Gastrointest Endosc, 2004, 59(6): 619626.
24. 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.

《中國普外基礎與臨床雜志》

多層螺旋CT血管造影在胃癌規范性根治術術前評估中的價值

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《中國普外基礎與臨床雜志》

多層螺旋CT血管造影在胃癌規范性根治術術前評估中的價值

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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