摘要
目的 评价CT对胸段食管癌伴两侧气管食管沟淋巴结的诊断价值及临床意义。方法搜集经三野淋巴结清扫术的胸段食管癌病例 46例 ,对照气管食管沟转移淋巴结的CT表现与病理改变。结果 46例病例中 ,14例有气管食管沟淋巴结转移 ,占 30 %。手术共取两侧气管食管沟淋巴结2 77枚 ,病理证实淋巴结转移 16枚 ,气管食管沟淋巴结转移与否与胸段食管癌部位及T分期无相关性(P >0 0 5 )。CT诊断两侧气管食管沟淋巴结转移 18枚 ,平均直径 1 0cm(0 3～ 2 5cm)。CT检查发现气管食管沟淋巴结个数的敏感性和特异性分别为 87 5 0 %和 98 47% ,阳性预测值 77 78% ,阴性预测值 99 2 3%。结论 (1)对食管癌病人而言 ,气管食管沟处出现结节 ,即可认为是淋巴结转移。 (2 )对不手术的放射治疗病人 ,下颈部及胸部CT检查应列为常规 ,并以此指导制订放疗计划。 (3)胸段食管癌两侧气管食管沟淋巴结清扫有临床意义 ,但如果CT显示两侧气管食管沟阴性 ,再加上临床检查两侧下颈部颈内静脉淋巴结链区以及两侧锁骨上区淋巴结阴性者 ,可选择性不行三野清扫 。
Objective To evaluate the clinical value of CT scan in the diagnosis of tracheoesophageal groove lymph node (TEGLN) metastasis of thoracic esophageal carcinoma. Methods Forty-six patients with thoracic esophageal carcinoma underwent esophagectomy with three-field dissection (3FD) of the cervical, mediastinal, and abdominal lymph nodes. CT findings of TEGLN were compared with that of pathological findings. Results Among the 46 patients who underwent esophagectomy with 3FD, 14 (30%) were found to have TEGLN metastases. Of the 277 TEGLNs excised by operation, 16 were found to have metastases. Primary sites of the thoracic esophageal carcinoma with TEGLN metastasis in upper, middle, or lower portion were 66.67%, 22.86%, and 40%, respectively. The difference between each portion was not statistically significant. The thoracic esophageal carcinoma with TEGLN metastasis in T 1, T 2, T 3 and T 4 staging were 50.00%, 25.00%, 28.57%, and 100.00%, respectively. There was no statistically significant difference between each T staging. 18 TEGLNs were found in CT scans. The average diameter of them was 1cm (0.3～2.5 cm). Sensitivity and specificity of CT examination were 87.50% and 98.47%, respectively. Positive predict value and negative predict value were 77.78% and 99.23%, respectively. Conclusion In patient with thoracic esophageal carcinoma, nodules appeared in tracheoesophageal groove could be diagnosed as lymph nodal metastases. Low cervical and mediastinal CT scan should be a conventional examination, and it was the basis of the radiation therapy plan. Dissection of TEGLN was very important for patient of thoracic esophageal carcinoma, but if bilateral tracheoesophageal grooves were negative in CT scans, and bilateral internal jugular chain and bilateral superclavicular lymph node were both negative in clinical examination. 3FD dissection, which could increase the rate of operative complication, was not conventionally used.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2002年第2期139-141,共3页
Chinese Journal of Radiology
关键词
食管肿瘤
淋巴转移
CT
诊断
食管癌
Esophageal neoplasms
Lymphatic metastasis
Tomography, X-ray computed
