胸段食管癌术后淋巴结转移213例CT分析

CT analysis on lymph node metastasis after operation of thoracic esophageal carcinoma

目的评价食管癌术后淋巴结转移的规律和CT检查的价值。方法回顾性分析213例胸段食管癌术后淋巴结转移的临床和CT资料。结果胸上段食管癌42例,中段112例,下段59例。淋巴结肿大呈圆形或浅分叶(251个)、强化不均和坏死(193个)、融合(97处)。淋巴结转移分布:下颈部42处,上纵隔60处,中纵隔105处,下纵隔28处,胃周和腹膜后71处,共306处,多部位转移77例。胸上、中段食管癌术后淋巴结转移以原位转移多见(P<0.01),且上行转移多于下行(P<0.01),但胸下段者以下行转移为主(P<0.01)。结论食管癌术后淋巴结转移CT表现为肿大、形态圆形或浅分叶、强化不均或坏死、融合。淋巴结转移的规律可作为食管癌术中淋巴结清除范围的参考。食管癌术后CT追踪有利于及时发现淋巴结转移,调整治疗方案。

Objective To evaluate the value of CT scanning for detecting lymph node metastasis （LNM） after operation of thoracic esophageal carcinoma and to analyze the regularity of LNM. Methods Clinical and CT data in 213 patients with LNMs,who underwent operation for thoracic esophageal caroinoma were analyzed retrospectively.Results Among 213 cases,the LNM lesions of upper thorax were found in 42,those of mid thorax in 112 and those of lower thorax in 59.On CT images ,213 patients had 306 lesions of LNM,of them,251 lesions appeared as round and shallow lobular form,193 lesions as non-homogeneous enhancement and necrosis,and 97 lesions as confluent.The distributions of total 306 LNMs comprised lower cervix （n=42）,superior mediastinum（n=60）,mid mediastinum （n=105）,inferior mediastinum （n=28）,perigastria and postperitoneum（n=71）. Multiple LNMs were found in 77 cases.In situ metastasis was significantly higher than the other spacewhen the lesions located in upper thorax and mid-thorax （P 〈 0.01）,and upward metastasis was significantly higher than downward metastasis（P 〈 0.01） but those of lower thorax were mainly downward metastases. Conclusion On CT images,LNMs usually appear as enlargement,round or shallow-lobular form,non-homogeneous enhancement or necrosis,and confluence.Understanding the regularity of LNM can provide the reference for determining the clearance extent.Postoperative follow-up of patients with esophageal carcinoma is very helpful for timely find LNMs and regulate therapeutic protocol.