双源CT检查对贲门癌手术的临床意义

Clinical value of dual-source CT in cardiac surgery

目的评价术前双源CT检查对判断贲门癌手术可行性的临床价值。方法对38例贲门癌患者行术前上腹部双源CT扫描,再将CT图像进行后处理,进而观察肿瘤浸润深度、外侵范围、周围淋巴结转移情况及胃左动脉间隙(胃左动脉游离段长度),并与术中情况对照,判断手术可行性并指导手术切除。结果 38例贲门癌患者双源CT所显示的癌肿大小、外侵范围、周围肿大淋巴结以及胃左动脉间隙都与术中所见基本吻合。其中,21例双源CT显示贲门肿块≤4.0 cm,与周围器官无粘连,且未发现肿大淋巴结,全部行根治性切除术;17例双源CT显示贲门肿块>4.0 cm,依其浸润程度和淋巴结转移情况,9例行根治性切除,7例行姑息性切除,1例探查手术。结论术前双源CT检查有助于明确贲门癌浸润深度、外侵范围、周围淋巴结转移情况和胃左动脉间隙大小,对判断手术可行性及指导手术切除具有重要的临床价值。

Objective To evaluate the clinical value of preoperative dual-source CT in judging the feasibility of cardiac cancer surgery. Methods 38 patients with cardiac cancer were performed by dual-source CT scanning in upper abdomen to analyze the feasibility of the cardiac surgery and guide the operation. The depth of tumor invasion, the lymph node of tumor involvement and the left gastric artery gap（ length of free left gastric artery） were observed to compare with the conditions in the surgery. Results In 38 cases of cardiac cancer, the size of the tumor, the infiltration depth, the intumescent lymph node shown by CT were consistent with conditions in the surgery. In 21 cases, CT showed that the size of cardiac cancer was less than or equal to 4.0 cm. There was no stick with surrounding organs and no intumescent lymph-gland was found, All were operated with radical excision, CT showed that the size of cardiac tumor was more than 4.0 cm in 17 cases. According to the infiltration degree and the situation of lymph-gland metastasis, the radical excision was conducted in 9 cases, the palliative resection in 7 cases and the exploratory surgery in 1 cases respectively. Conclusions The preoperative dual-source CT examination contributes to deciding the infiltration depth, invasion extent of the cardiac cancer and the status of local lymph node metastasis, has significant clinical value in judging the feasibility of operation and directing the excision in operation.