de Manzoni G, Macrì A, Borzellino G, Cordiano G
1st Department of General Surgery, Verona University Medical School, Borgo Trento Hospital, Italy.
Surg Endosc. 1994 Jul;8(7):765-9. doi: 10.1007/BF00593437.
The correct staging is of crucial importance in the choice of surgical treatment in patients affected by stomach carcinoma. In an attempt to achieve a greater accuracy in the diagnosis of depth of tumor invasion, we propose to perform ultrasonography of the gastric wall during surgery (in vitro ultrasonography). Immediately after removal by the surgeon, the portion of the stomach containing the tumor is submitted to ultrasonography with a linear 7.5-MHz probe. To obtain good ultrasonographic images it was necessary to interpose an echo-free standoff pad between the probe and the gastric wall and between the latter and support surface. On completion of ultrasonography, the surgical specimen was sent to the pathologist, who was unaware of the diagnosis formulated on the basis of in vitro ultrasonography (VUS). The VUS diagnosis of T corresponded to the pathological diagnosis in 87/93 cases (93.5% accuracy). In the early cancers the diagnosis was correct in 24/28 cases (85.7%); in the advanced cancers the diagnosis was correct in 63/65 cases (96.9%). In comparison with the results of the other preoperative and intraoperative techniques the accuracy of in vitro ultrasonography in diagnosing the depth of tumor invasion was clearly superior. We feel that VUS may become a basic instrument in T staging and an aid to the surgeon in deciding the extent of the resection and of lymphadenectomy in patients with gastric cancer.
正确的分期对于胃癌患者手术治疗方案的选择至关重要。为了提高肿瘤浸润深度诊断的准确性，我们建议在手术过程中对胃壁进行超声检查（体外超声检查）。外科医生切除肿瘤后，立即用7.5兆赫的线性探头对包含肿瘤的胃部分进行超声检查。为了获得良好的超声图像，有必要在探头与胃壁之间以及胃壁与支撑面之间插入一个无回声隔离垫。超声检查完成后，将手术标本送检病理科医生，该医生不知道基于体外超声检查（VUS）得出的诊断结果。VUS对T的诊断与病理诊断相符的有87/93例（准确率93.5%）。在早期癌症中，诊断正确的有24/28例（85.7%）；在进展期癌症中，诊断正确的有63/65例（96.9%）。与其他术前和术中技术的结果相比，体外超声检查在诊断肿瘤浸润深度方面的准确性明显更高。我们认为VUS可能成为T分期的基本手段，并有助于外科医生确定胃癌患者的切除范围和淋巴结清扫范围。
