食管癌术前的螺旋CT征象与手术切除率的关系研究

Study of relation between the helical CT signs of esophageal carcinoma and the rate of resection

目的对食管癌患者术前应用胸部螺旋CT检查以判断食管肿瘤与周围组织关系,并对判断食管癌手术切除率的方法和标准进行研究.方法该院自1995年3月～2003年5月对所有食管癌患者均采用术前胸部螺旋CT平扫加增强,根据CT影象学征象并结合术中肉眼所见及手术切除情况进行统计学处理.结果术前根据食管癌胸部螺旋CT征象将患者分为A组(食管病变与周围重要组织之间有脂肪垫存在)、B组(脂肪垫消失长度在2 cm以下)、C组(脂肪垫消失长度大于2 cm)三组;手术切除率为A组根治率100.0%,B组根治率84.5%,C组根治率17.8%.结论食管癌术前应用胸部螺旋CT检查并对肿瘤与周围重要组织关系进行定性及定量分析较之传统的单纯以长度作为能否切除的标准更符合实际需要,对指导手术有很大的意义,明显降低了开胸探查率.

objective: Applying chest helical computed tomography (CT) to judge the relationship of the esophageal carcinoma and the surrounding structures, and evaluate the methods and the criterion of esophageal carcinoma resection. Methods: Chest helical CT scanners with dynamic contrast enhancement accentuate the tumor location of all the patients with esophageal carcinoma. Statistical management was made based on naked eye finding in surgery and helical CT signs of esophageal carcinoma. Results: According to the preoperative helical CT signs three groups were defined, group A were those who have fat pad between the esophageal carcinoma and the surrounding important structures, group B were those whose extinctive length of fat pad was smaller than 2 cm, and the group C were those more than 2 cm. The radical resection rate of group A, B,C were 100%, 84.5%, 17.8% respectively. Conclusions: Applying chest helical CT to judge the relationship of esophageal carcinoma with the surrounding structures is more reasonable than the traditional excisional criterion only based the tumor length.