Computed Tomography in Prediction of Resectability of Gastric Cancer

手術前電腦斷層攝影預測胃癌切除可行性

劉振華(Jenn-Hwa Liu) ； 陳儉鏗(Gran-Hum Chen) ； 楊建芳(Chien-Fang Yang) ； 劉自嘉(Tse-Jia Liu)

《中華放射線醫學雜誌》 14卷3期 (1989/09) Pp. 205-211

摘要

本院為評估末期胃癌患者手術切除可行性，實施手術前電腦斷層攝影預測胃癌分期及切除可行性。
自民國72年6月至77年12月，共有143例胃癌患者接受手術前電腦斷層攝分期：第一期：胃癌胃壁厚度小於一公分，第二期：胃癌厚度大於一公分但無周邊侵潤無淋巴結轉移，第三期：局部淋巴結轉移但無周邊器官侵潤或遠端轉移，第四期：周邊器官侵潤或遠端轉移。預測胃癌分期準確率75%，以第四期敏感性83%、特異性94%最佳。電腦斷層攝影預測腹部淋巴結轉移準確率不定、預測主動脈旁淋巴結轉移準確率特佳。
預測肝臟轉移：敏感性80%、特異性97%，胰臟轉移：敏感性64%、特異性96%。胃癌分期第四期預測根治性胃切除術準確率為90%。
手術前電腦斷層攝影胃癌分期接近病理TNM分期，以第四期診斷率最高，可預估根治性胃切除術之可行性。部腹探查術只能避免於第四期胃癌合併多發性肝臟轉移、胰臟頭部侵潤、惡性腹水、腹膜轉移、主動脈周圍侵潤超過90°，且無明顯幽門阻塞之患者。

並列摘要

The value of pre-operative CT staging in predicting radical resectability was done in 143 patients with proved gastric adenocarcinoma. According to Dr. Moss's criteria and clinical-TNM system, CT staging of gastric cancer was divided into four stages. The overall accuracy in CT staging comparing with pTNM staging was 75%, and it was especially valuable in stage IV with sensitivity 83% and specificity 94%. CT predicting lymphnode metastasis was variable but was specific in para-aortic lymph node. The accuracy of CT predicting liver metastasis was 80% in sensitivity and 97% in specificity, but was only 64% in sensitivity and 96% in specificity in predicting pancreatic invasion The accuracy in CT staging IV predicting radical resectability rate was 90%. This result confirms that CT staging is closely correlated to pTNM stage and specific for stage IV. Exploratory laparotomy should be avoided in CT staging IV cases with multiple liver metastasis, pancreatic head invasion, omental seeding and para-aortic invasion more than 90 in circle without pyloral outlet obstruction.

並列關鍵字

CT staging ； gastric cancer ； radical resectability