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위암의 병기와 복부초음파 소견

Other Titles
 Abdominal ultrasonography of fluid-filled stomach for staging of gastric cancer 
Issue Date
1992
Description
의학과/석사
Abstract
[한글] 위암은 가능한 치유절제가 되어야 예후가 좋기 때문에 수술전에 병기결정이 그 만큼 중요하다. 그러나 지금까지는 전산화단층촬영이나 복부초음파검사로 주변 장기 침윤, 임파절 또는 원격전이 여부만을 주로 관찰하였고 원발병소인 위벽에 대한 심달도는 파악하기 어려웠으나 1980년부터 내시경초음파기기가 개발됨으로써 위병변의 심달도 파악이 가능하게 되었는데 아직 이 기기가 널리 보급되어 있지 못하고 검사에 따르는 고통이 있는 문제점이 있다. 그런데 초음파검사 기기가 발전됨에 따라 영상이 좋아졌고, 위를 물로 채우면 위벽에 대한 층상구조도 파악할 수 있어 심달도 진단이 가능하다. 이에 저자는 내시경검사 및 조직생검으로 위암이 확인된 49예의 환자를 대상으로 수술 전 병기결정을 위하여 물을 마시게 하고 복부초음파검사를 시행하여 위암의 심달도, 임파절 및 원격장기의 전이여부를 진단하고 수술 및 조직병리학적 병기와 비교함으로써 복부초음파검사의 병기판정의 정확도을 평가하고 임상적 유용성을 알아보고자 하였다. 대상 예들을 8시간이상 금식시킨 후 복부초음파검사를 시행하였으며 원격전이 유무를 먼저 관찰한 후 보리차 600cc를 마시게 하고 여러 체위에서 위암의 심달도 및 임파절 전이 여부를 조사하였다. 초음파검사상 판정된 병기는 수술후 절제된 조직의 병리학적소견 또는 절제를 할 수 없었먼 경우에는 수술소견과 비교하여 정확도를 판정하였고 위암의 위치, 궤양유무 및 진행암의 경우 Borrmann 분류애 따른 정확도의 차이를 분석하였다. 위암의 병기를 American Joint Committee on Cancer(AJCC,1988)의 TNM 분류에 의거하였을 때, 위암의 심달도는 49예중 35예(71.4%)에서 일치하였으며 실제 병변보다 초음파소견이 과대평가된 경우가 10예(20.4%) 및 과소진단된 경우가 4예(8.2%)였다. T 병기별로는 T 1 및 T2의 경우 정확도가 각각 33.3% 및 64.3%로 다소 낮았으나, T3 및 T4의 경우는 각각 80% 및 100%의 정확도를 보여 절제가능성 여부를 판정하는데 매우 유용하다고 생각되었다. 임파절전이는 49예중 31예(63.3%)에서 일치하였으며, 18예(36.7%)는 과소진단되었고 과대진단된 경우는 없었으며, N 병기별로는 NO의 경우 정확도가 100%였으나, Nl은 35.7%, N2는 47.1% 였다. 원격전이의 판정은 46예(93.9)에서 일치하였다. 한편 심달도 판정의 정확도가 위암의 위치, 궤양의 동반여부 및 진행암의 경우 Borrmann분류에 따라 차이가 있는지를 비교하였으나 통계적인 차이는 없었다. 이상의 결과로 위암환자에서 물을 마시게 한 후 시행하는 복부초음파검사는 위암의 심달도, 임파절전이 및 원격전이 여부를 판정하는데 효과적이며 특히 췌장등의 주변장기로의 침윤여부 판정에 정확도가 높으므로 수술전 절제가능성 여부 판정에 유용한 검사법이 라고 생각된다. Abdominal Ultrasonography of Fluid-filled Stomach for Staging of Gastric Cancer Sung Pyo Hong Department of Medical Science The Graduate School, Yonsei University (Direcred by Professor In Suh Park) The evaluation of tumor extent is important in the diagnosis and management of malignant tumor. In the case of stomach cancer, preoperative demonstration of tumor spread to the surrounding structures and distant organs has been performed by computed tomography(CT) and ultrasound(US). Recently endoscopic ultrasound was known to be effective in the assessment of invasion depth of gastric cancer. However transabdominal ultrasound of stomach after fluid ingestion made it possible to visualize all layers of gastric wall with high degree of image resolution. In 49 patients of stomach cancer, ultrasound examination was done immediately after 600㏄ water ingestion prior to surgery and the image findings were analyzed in all patients on the base of invasion depth and tumor extent. Consecutively ultrasound image findings were compared with histologic ones in order to assess the accuracy of ultrasound of fluid-filled stomach for staging of stomach cancer. The results were as follows: 1. The overall accuracy rates for the diagnosis of the depth of cancer invasion were 71.4%. The depth of cancer invasion was overestimated in 10patients(20.4%) and underestimated in 4 patients(8.2%). Diagnostic accuracy rates for T3 and T4 were 80% and 100% respectively. 2. The diagnostic accuracy rates for the depth of cancer invasion in 39 patients with ulceration were 69.2% and 10 patients without ulceration were 80%. 3. The diagnostic accuracy rates for the depth of cancer invasion were not. different in relation to location of the lesion or to Borrmann's types. 4. Lymph node metastasis was correctly diagnosed in 31 of 49 patients(63.3%) and incorrectly diagnosed in 18 patients(36.7%). The sensitivity was 54.8% and specificity 100%. The positive predictive value was 100% and the negative predictive value was 56.3%. 5. In the evaluation of distant metastasis, ultrasonography was accurate in 46(93.9%), of 49 patients and in 3 cases a false-negative diagnosis was made. The sensitivity was 57.1% and specificity 100%. The positive predictive value was lOO% and the negative predictive vague was 93.3%. 6. In stage grouping of stomach cancer, the overall accuracy rate for transabdominal ultrasonography after water ingeston was 55.1%.
[영문] The evaluation of tumor extent is important in the diagnosis and management of malignant tumor. In the case of stomach cancer, preoperative demonstration of tumor spread to the surrounding structures and distant organs has been performed by computed tomography(CT) and ultrasound(US). Recently endoscopic ultrasound was known to be effective in the assessment of invasion depth of gastric cancer. However transabdominal ultrasound of stomach after fluid ingestion made it possible to visualize all layers of gastric wall with high degree of image resolution. In 49 patients of stomach cancer, ultrasound examination was done immediately after 600㏄ water ingestion prior to surgery and the image findings were analyzed in all patients on the base of invasion depth and tumor extent. Consecutively ultrasound image findings were compared with histologic ones in order to assess the accuracy of ultrasound of fluid-filled stomach for staging of stomach cancer. The results were as follows: 1. The overall accuracy rates for the diagnosis of the depth of cancer invasion were 71.4%. The depth of cancer invasion was overestimated in 10patients(20.4%) and underestimated in 4 patients(8.2%). Diagnostic accuracy rates for T3 and T4 were 80% and 100% respectively. 2. The diagnostic accuracy rates for the depth of cancer invasion in 39 patients with ulceration were 69.2% and 10 patients without ulceration were 80%. 3. The diagnostic accuracy rates for the depth of cancer invasion were not. different in relation to location of the lesion or to Borrmann's types. 4. Lymph node metastasis was correctly diagnosed in 31 of 49 patients(63.3%) and incorrectly diagnosed in 18 patients(36.7%). The sensitivity was 54.8% and specificity 100%. The positive predictive value was 100% and the negative predictive value was 56.3%. 5. In the evaluation of distant metastasis, ultrasonography was accurate in 46(93.9%), of 49 patients and in 3 cases a false-negative diagnosis was made. The sensitivity was 57.1% and specificity 100%. The positive predictive value was lOO% and the negative predictive vague was 93.3%. 6. In stage grouping of stomach cancer, the overall accuracy rate for transabdominal ultrasonography after water ingeston was 55.1%.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117386
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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