目的：探讨Borrmann Ⅳ型胃癌胃镜(EG)和螺旋CT(MSCT)的特征，比较胃镜与螺旋CT在术前特异性诊断Borrmann Ⅳ型胃癌的准确性。方法：回顾性分析笔者所在医院2005年5月-2015年5月10年间收治的53例Borrmann Ⅳ型胃癌患者的胃镜及螺旋CT资料，以术后病理结果为标准，比较胃镜与螺旋CT在术前特异性诊断Borrmann Ⅳ型胃癌的准确性。结果：胃镜下肿瘤主要以胃窦部病变为主(37.7%)，伴胃腔缩小、狭窄变形(52.8%)，胃壁僵硬，充气后明显不张(50.9%)，活检病理以低分化腺癌为主(50.9%)。螺旋CT 49例(92.5%)表现为胃壁局限性或广泛性不规则增厚，病灶与正常胃壁分界不清，增强后显示增厚胃壁明显强化；29例(54.7%)表现为病变处胃浆膜面毛糙，与周围脂肪间隙模糊不清或消失。MSCT术前诊断Borrmann Ⅳ型胃癌的准确性显著高于EG加活检，差异有统计学意义(P<0.05)。结论：Borrmann Ⅳ型胃癌具有一定的胃镜及影像学特征，在术前特异性诊断中，螺旋CT准确性明显高于胃镜。%Objective:To compare the accuracy of electronic gastroscopy(EG) and multi-slice CT(MSCT) in the preoperative specificity diagnosis of Borrmann type Ⅳ gastric cancer by studying EG and spiral CT features.Method:The EG and MSCT data of 53 cases of Borrmann type Ⅳ gastric cancer patients in our hospital from May 2005 to May 2015 were retrospectively analyzed.On the basis of postoperative pathologic results,the accuracy of EG and MSCT in the preoperative specificity diagnosis of Borrmann type Ⅳ gastric cancer was compared.Result:Under gastroscope,tumors were mainly composed of the distal lesions(37.7%),associated with gastric lumen narrowing and narrow shape(52.8%),with stomach wall stiffness,inflatable clearly shrunken(50.9%).By the biopsy pathology it was given priority to with poorly differentiated adenocarcinoma(50.9%).The spiral CT of 49 cases(92.5%) performed that the stomach showed limitations or diffuse irregular thickening,the boundary of lesions and normal gastric wall was not clear.By enhance imaging it showed that the thickened stomach wall was obviously enhanced.29 cases(54.7%) characterized by coarse gastric serous membrane surface and the clearance with the surrounding fat was blurred or disappeared. The diagnostic accuracy of MSCT in the preoperative specificity diagnostic of Borrmann Ⅳ was higher than EG and biopsy,the difference was statistically significant(P<0.05).Conclusion:Borrmann type Ⅳ gastric cancer has certain gastroscope and imaging characteristics.The accuracy of MSCT is significantly higher than EG in the preoperative specificity diagnosis of Borrmann Ⅳ gastric cancer.
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