双重对比造影在鉴别食管良恶性狭窄的应用

The clinical application of double-contrast esophagograms in differentiating benign and malignant strictures of the esophagus

目的:探讨双重对比造影在鉴别食管良恶性狭窄的应用价值。方法:53例双重对比造影显示为食管狭窄的患者,根据影像学特点分为良性狭窄、中性狭窄及恶性狭窄,与食管镜病理结果进行对照分析。结果:在53例食管狭窄的病例中,双重对比造影检查诊断为良性狭窄20例(37.7%),恶性狭窄28例(52.8%),中性狭窄5例(9.4%),在显示良性狭窄的20例中,食管镜均未发现恶性病变18例(90%),证实有良性狭窄,余2例(10%)在食管镜下未发现明确狭窄。恶性狭窄28例(100%)经食管镜均证实为恶性病变。中性狭窄的5例患者中4例(80%)经食管镜证实为良性狭窄,余1例(20%)为食管癌。结论:双重对比食管造影显示为良性狭窄的病例,不需进一步行食管镜检查而直接进行治疗;双重对比食管造影显示为中性狭窄及恶性狭窄的病人,需早期行食管镜检查明确诊断。

Objective： To evaluate the of double-contrast esophagograms for differentiating benign and malignant strictures of the esophagus. Methods：A search of radiology and endoscopy files revealed 53 patients with esophageal strictures on double-contrast esophagograms who underwent endoscopy. The observers classified the strictures as having a benign, malignant, or equivocal appearance. The radiographic data were correlated with the endoscopic and pathologic findings to determine the usefulness of double-contrast esophagograms for differentiating benign strictures from malignant tumor. Results： Of the 53 esophageal strictures detected on double-contrast esophagograms, 20 （37.7%） had a benign radiographic appearance, 28 （52.8%） had a malignant appearance, and 5 （9.4%） had an equivocal appearance. None of the 20 patients with radiographically benign strictures had malignant tumor on endoscopy, which revealed benign strictures in 18（90%） patients and no definite strictures in the remaining 2（10%）. Conversely, all 28 patients （100%） with radiographically malignant strictures had malignant tumor on endoscopy. Finally, 4 （80~） of 5 patients with radiographically equivocal strictures had benign strictures without tumor on endoscopy and one （20%） had esophageal carcinoma. Clusions： Radiographically benign esophageal strictures are not found to be caused by malignant tumor on endoscopy, so these patients can be treated medically before endoscopy are performed. However, radiographically malignant or equivocal strictures require early endoscopy and biopsy for a definitive diagnosis.