食管腔内超声在食管癌患者中的应用

Clinical application of transesophageal intraluminal ultrasonography to the esophageal carcinoma

目的研究经食管探头超声仪（ＴＥＥＰ）在食管癌诊断和治疗中的应用价值。方法１９９６年９月至１９９７年８月，３２例食管癌患者术前进行上消化道钡餐、纤维胃镜和ＴＥＥＰ等检查。其中７例患者术前予以ＣＴ扫描检查。所有患者切除的标本，包括淋巴结，均送病理检查，并将术前ＴＥＥＰ和ＣＴ检查情况与术中、术后病理结果进行对比分析。结果纤维胃镜、ＴＥＥＰ和病理所测的肿瘤长度分别为４５２４±１８０６ｃｍ（ｘ±ｓ）、５２６９±１９１６ｃｍ（ｘ±ｓ）和５３４５±１９０１ｃｍ（ｘ±ｓ）。纤维胃镜测的肿瘤长度与病理结果比较，差异有显著性意义（Ｐ＜００５），而ＴＥＥＰ测的肿瘤长度与病理结果比较，差异无显著性意义（Ｐ＞００５）。ＴＥＥＰ术前Ｔ、Ｎ分期的准确率分别为８０６％（２５／３１）和７７３％（３３／４４），而ＣＴ术前Ｔ分期的准确率仅为４２９％（３／７）。结论对于食管癌的术前ＴＮ分期，ＴＥＥＰ是一项可靠的检查手段。ＴＥＥＰ比ＣＴ准确。在测量食管癌肿瘤长度时，ＴＥＥＰ比胃镜精确。该检查手段安全，在我们的临床应用中，未出现任何并发症。

Objective To study the value of transesophageal echo probe (TEEP) in preoperative staging of esophageal carcinoma. Method Between September 1996 and August 1997,32 patients(22 men and 10 women) with esophageal carcinoma, aged 49 to 72 years (mean age, 55 2 years), underwent surgery. Preoperative examinations included upper gastrointestinal series, endoscopy, and TEEP. Seven of these patients also received CT scan. Resected specimens of the esophagus and lymph nodes were examined histopathologically, and the results of TEEP and CT were compared with intraoperative macroscopic findings and pathologic results. Result The tumor length measured by gastroscopy, TEEP and pathology was 4 524±1 806 cm, 5 269±1 916 cm, and 5 345±1 901 cm, respectively. There was a significant difference between the results of gastroscopy and ose of pathology ( P <0 05),but no significant difference was seen between the results of TEEP and those of pathology ( P >0 05). The accuracyof TEEP for predicting T and N staging was 80 6%(25/31) and 77 3% (34/44),respectively. The accuracy of CT for predicting T staging was only 42 9%. Conclusion TEEP is a reliable method for the preoperative TN staging of esophageal carcinoma and it is more accurate than CT. TEEP is more accurate than gastroscopy in measuring the length of esophageal cancer.In our experience,the procedure is safe without any complications.