目的评估盆腔CT扫描在胃腺癌 临床分期中的价值与必要性及胃腺癌盆腔 CT出现转移性病灶的相关因素。方法 收 集2013年1月至2017年7月我院经病理证实 且于治疗前行全腹CT检查(包含盆腔CT)的 胃腺癌202例。查阅报告和CT图像记录盆 腔CT检出的异常改变，将其分为转移相关 与非转移相关两大类，前者再分类为孤立 性或非孤立性转移灶，孤立性者定义为在 盆腔外其他部位未发现转移灶。同时，比 较不同部位胃腺癌患者以及平扫与增强 CT检查对盆腔CT转移性病灶检出率的影 响，并经统计学分析，以P?0.05为差异有 统计学意义。结果 本组202例中有45例 (22.3%)盆腔CT发现异常征象，最常见盆 腔积液(17例，占8.4%)。检出盆腔转移性 病灶7例(3.5%, 95% CI 0.9%-6%)，包括 骨转移2例、腹膜结节状增厚1例、淋巴结 增大1例、直肠-乙状结肠肠壁增厚1例、 皮下软组织结节2例，其中孤立性盆腔转 移灶4例(2.0%, 95%CI 0.1%-3.9%)。发生 于不同部位的胃腺癌以及平扫与增强CT对 盆腔转移灶的检出率差异无统计学意义 (P=0.816, P=0.650, P=0.851)。结论 综 合考虑医疗成本、辐射剂量及实际的应用 效果，在胃腺癌治疗前影像学检查中不建 议常规应用盆腔CT检查，可在临床怀疑有 盆腔异常时加以选择。

Objective The objective of this study was to evaluate the value and necessity of pelvic CT examination in gastric cancer (GC) staging. Methods We reviewed the medical records of pathologically proved GC patients who had abdominopelvic CT examination for staging at our institution from January 2013 through July 2017. These pathology findings seen in the pelvis were classified into 2 categories as metastatic disease or not. Metastatic diseases were further categorized as isolated pelvis metastasis or not, and isolated pelvis metastasis was defined as the presence of pelvis metastasis without any other sites of metastasis on CT scan. Comparisons of incidence of pelvis metastases between patients with GC located in different stomach sites and between patients with enhanced CT and with non-enhanced CT were performed. Results A total of 202 patients with GC received abdominopelvic CT examinations at our institution during study period. 22.3% (n=45) of patients had findings in the pelvis, and the most common was ascites (8.4%, n=17). The metastatic diseases in pelvis were found in 3.5% (95%CI 0.9%-6%, n=7) of patients, including bone lesions (n=2), peritoneal thickening or nodules (n=1), lymphatic spread (n=1), intestinal wall thickening (n=1), and subcutaneous nodule (n=2). Isolated pelvis metastasis were found in 2.0% (95%CI 0.1%-3.9%, n=4) of all CT examination. The differences of incidence of pelvis metastases between patients with GC located in different stomach sites and between patients with enhanced CT and with non-enhanced CT were not significant (P=0.816, P=0.650, P=0.851). Conclusion In consideration of the limited yield of pelvic CT, health care cost, and radiation dose, the pelvic CT should not be performed routinely and should be reserved only for GC patients with suspected pelvic abnormalities.