食管癌气管食管沟淋巴结转移

Tracheoesophageal groove lymph node metastasis of esophageal cancer

目的评价ＣＴ对食管癌气管食管沟淋巴结的诊断价值。方法搜集经病理证实的食管癌气管食管沟淋巴结病例３７例，行ＣＴ检查，平扫１０例，增强扫描２７例。结果（１）各段食管癌均可引起气管食管沟淋巴结转移，左右两侧表现不一致。右侧淋巴结绕着气管右后壁生长呈“Ｌ”形，边界不清晰，密度多均匀，致气管右后壁受压狭窄呈不规则状，甚至气管左移，局部颈总动脉和颈内静脉被推向外或前外。而左侧淋巴结呈结节状紧贴气管左壁，气管以右移为主，局部颈总动脉和颈内静脉被推向外或后外。（２）颈段食管癌伴局部淋巴结转移时，应以ＣＴ作为治疗定位标准。（３）颈部转移淋巴结的大小与食管癌局部病变的大小不呈平行关系。（４）食管癌气管食管沟淋巴结转移，需与甲状腺癌、气管癌、环后区癌、神经源性肿瘤鉴别。结论掌握食管癌气管食管沟淋巴结ＣＴ特征，有助于正确诊断，可为临床进一步治疗提供依据。

Purpose To evaluate the value of CT in diagnosis of tracheoesophageal groove lymph node metastasis of esophageal cancer. Methods 37 cases with tracheoesophageal groove metastatic lymph node from esophageal cancer which were confirmed by pathology were analyzed. Results (1)Tracheoesophageal groove lymph node metastasis could arise from every portion of esophageal cancer. The manifestation of the right was different from the left. On the right, metastatic lymph nodes grew around the posterolateral wall of trachea and took the form of “L”.The margin was unclear. The density was mostly homogeneous. The trachea was irregularly stenosed and even displaced because of pressure. Common carotid artery and internal jugular vein were pushed the laterally or anterolaterally. On the left, the metastatic lymph nodes were nodular and was attached to the left lateral wall of the trachea. The trachea was mostly shifted to the right. The common carotid artery and internal jugular vein were pushed laterally or posterolaterally. (2)CT should be the criteria to determine the port of radiotherapy in treatment of tracheoesophageal groove metastatic lymph node of esophageal cancer. (3)The size of metastatic lymph node was not parallel with the local lesion of esophageal cancer. (4)Tracheoesophageal groove lymph node metastasis of esophageal cancer should be differentiated from thyroid carcinoma、tracheal carcinoma、hypopharyngeal carcinoma and neurogenic tumour. Conclusion Recognition of CT features of tracheoesophageal groove lymph node metastasis of esophageal cancer is helpful in making accurate diagnosis. It is the basis of clinical treatment.