MSCT诊断胸段食管癌喉返神经链淋巴结转移及其临床意义

Diagnostic and clinical value of MSCT in evaluation of recurrent nerve lymph node metastasis of thoracic esophageal carcinoma

目的评价MSCT诊断胸段食管癌喉返神经链淋巴结转移的效能及临床意义。方法连续随机选择经食管镜或胃镜证实、拟行三野清扫的胸段食管癌患者72例,观察测量MSCT所示喉返神经链淋巴结的长径、短径及个数,计算其长短径之比,判断转移情况,与术后病理对照。结果 72例患者中,24例(24/72,33.33%)伴有喉返神经链淋巴结转移。手术共取两侧喉返神经链淋巴结213枚,病理证实转移淋巴结33枚;喉返神经链淋巴结转移与浸润深度、分化程度有关(P均<0.05),与病变部位、病变长度无关(P均>0.05)。MSCT检测喉返神经链淋巴结的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为81.82%(27/33)、86.67%(156/180)、52.94%(27/51)、96.30%(156/162)和85.92%(183/213)。结论 MSCT诊断胸段食管癌喉返神经链淋巴结转移的特异度和准确率较高,可为术前制定治疗方案提供可靠依据。

Objective To explore the efficiency and clinical value of MSCT in diagnosis of recurrent nerve lymph node metastasis of thoracic esophageal carcinoma. Methods Seventy-two patients with pathologically proved esophageal carcinoma who underwent three-field dissection were enrolled. The lymph node＇s short-axis, long-axis, long-to-short-axis ratio and number in recurrent nerve region were evaluated with MSCT compared with postoperative pathology. Results Among 72 patients, recurrent nerve lymph node metastases were detected in 24 （24/72, 33.33%） patients. Of 213 recurrent nerve lymph nodes excised by surgical operation, metastases were proved in 33 of them. Recurrent nerve lymph node metastasis significantly correlated with depth of invasion and degree of tumor differentiation （both P〈0.05）, but not with the location and length of the tumor （both P〉0.05）. The sensitivity, specificity, positive predict value, negative predict value and accuracy rate of MSCT for detecting recurrent nerve lymph nodes was 81.82% （27/33）, 86.67% （156/180）, 52.94% （27/51）, 96.30% （156/162） and 85.92% （183/213）, respectively. Conclusion MSCT has high specificity and accuracy in diagnosing recurrent nerve lymph nodes metastasis, which can provide evidences for predicting operation scheme.