超声在食管癌淋巴结转移诊断中的应用价值

Application value of ultrasonography in diagnosis for lymphnodes metastasis of esophageal carcinoma

目的探讨超声检查在食管癌淋巴结转移诊断中的应用价值。方法采用常规超声对250例食管癌患者行食管周旁、双侧颈部及腹腔淋巴结扫查,依据手术病理检查结果将检出的淋巴结分为增生组与转移组进行超声与病理诊断结果对照分析。结果 250例食管癌病理诊断淋巴结转移320个,术前超声检出肿大淋巴结330个。其中病理证实淋巴结癌转移270个(转移组),淋巴结反应性增生60个(增生组)。与手术病理结果比较,术前超声对食管周旁、右颈气管旁三角区、左侧锁骨上窝及腹腔转移性淋巴结的检出率分别为62.4%(68/109)、98.9%(96/97)、95.7%(66/69)及88.9%(40/45);术前超声显示右颈气管旁三角区内淋巴结转移率为35.6%,(96/270),明显高于左侧颈部淋巴结转移率24.4%,(66/270)及腹腔淋巴结转移率14.8%,(40/270),差异有统计学意义(P均<0.05)。转移组淋巴结声像图特征:(1)淋巴结形态:85.6%(231/270)短径/长径比例(S/L)>0.5,呈圆形或类圆形;26.3%(71/270)呈多个融合状;(2)回声:81.1%(219/270)淋巴结内呈不均匀低回声团,无正常淋巴结门及髓质部稍高回声区;(3)血供:66.7%(180/270)淋巴结内部血供较丰富。结论术前超声提示食管癌淋巴结转移率及转移范围对患者手术方式选择及预后判断有重要临床意义。

Objective To assess the value of ultrasonography in the diagnosis of lymph node metastasis in esophageal carcinoma. Methods Two hundred and fifty patients with esophageal carcinoma were examined by uhrasonography . The thickness and echo of the esophageal wall were observed . Results Pathological examination showed that 270 lymph nodes were metastatic （metastasis group） and sixty were reactive hyperplasia （hyperplasia group） in 330 lymph nodes of 250 patients with esophageal carcinoma. Compared with the results of pathological examination, the checkout rate of lymph node metastasis （ LNM ） around esophageal, in the right paratracheal triangle, the left bilateral supraclavicular region and abdomen with uhrasonography was 62.4% （ 68/109 ）, 98.9% （ 96/97 ）, 95.7% （ 66/69 ） and 88.9% （40/45）, respectively, the high rate of lymph node metastasis in the fight paratracheal triangle was 35.6% （96/270） , which was higher than those of the left cervical and abdominal lymph node （ P 〈 0.05 ）. The ultrasonic features included： （1） Lymphnodes form： In metastic lymphnodes, 85.6% （231/270） with round or approximately round and the lymphnodes apeared to be mixed together in 26.3% （ 71/270 ） ; （ 2 ） Ehco ： 81.1% （219/270） of heterogeneous echogeniety ; （ 3 ） Blood supply ： 66.7% （ 180/270 ） with abundant blood supply. Conclusions The metastasis rate and scope of the lymph node in esophageal carcinoma before operation could be shown by uhrasonography, which possesses a key clinical value in selecting appropriate surgical procedure and identification of curative effect.