多层螺旋CT对不同术式食管癌患者术后的影像跟踪与评估

The image tracking and evaluation by using multi-slice spiral CT for esophageal cancer patients after different surgical procedures

目的探讨多层螺旋CT对食管癌患者不同术式后的影像跟踪与评估价值。方法选取滁州市第一人民医院2014年4月—2018年6月收治的60例食管癌患者,根据手术方式的不同将研究对象分2组,其中左、右胸入路术式各30例,分别于手术后1~3 d、1周以及出院后2年内每3个月随诊复查多层螺旋CT,对术后近期和远期并发症的类型及例数进行统计,分析2组术式近期和远期不同并发症的发生率及影像学特点。不同术式与近、远期并发症的相关性采用多元回归分析。结果通过128层螺旋CT检查发现,60例食管癌患者术后出现肺部炎症28例、胸腔积液58例,肺不张36例,液气胸22例,胸壁皮下气肿36例,纵隔气肿7例,吻合口瘘7例,远期发生吻合口狭窄6例、肿瘤复发7例、转移44例(包括淋巴结、骨骼、肝脏、肺、脑、肾上腺、胸腹膜等器官)。食管癌右胸入路术式组肺部炎症、吻合口瘘的发生率比左胸入路组低(均P<0.05),其余并发症组间发生率差异无统计学意义(均P>0.05)。手术方式与肺部炎症、吻合口瘘发生率有相关性(均P<0.05),与其他近、远期并发症无明显相关性(均P>0.05)。结论食管癌患者右胸入路术后出现肺部炎症及吻合口瘘的概率较低,CT能直观且准确地评估患者术后近、远期常见并发症,为临床治疗方案的选择提供可靠依据。

Objective To study the value of multi-slice spiral CT in tracking and evaluating the postoperative images of esophageal cancer patients treated with different surgical procedures.Methods Total 60 patients with esophageal cancer were selected from the First People's Hospital of Chuzhou City from April 2014 to June 2018.The patients were divided into two groups and were treated with left and right thoracic approach,which includes 30 cases respectively.The treat-ment was followed-up with multi-slice spiral CT 1 to 3 days,or 1 week after operation and multi-slice spiral CT was per-formed for the patients every 3 months within the next two years after discharge.The types and cases of short-term and long-term complications were analyzed.The incidence and imaging characteristics in the two groups of different complica-tions after operation were also analyzed.Multiple regression analysis was used to analyze the relationship between different surgical procedures and short-term and long-term complications.Results On 128-slice spiral CT scans,there were 28 cases of pulmonary inflammation,58 cases of pleural effusion,36 cases of atelectasis,22 cases of hydropneumothorax,36 cases of subcutaneous emphysema of chest wall,7 cases of pneumomediastinum,7 cases of anastomotic fistula,long-term anastomotic stenosis occurred in 6 cases,tumor recurrence in 7 cases,metastasis in 44 cases(including lymph node,bone,liver,lung,brain,adrenal,pleuroperitoneum and other organs).The incidence of pulmonary infection and anastomotic fistula in the right thoracic approach group of esophageal cancer were lower than those in the left thoracic group(all P<0.05).There was no difference in the incidence of the other complications among the groups(all P>0.05).There was a correlation between operation mode and pulmonary infection and anastomotic fistula(all P<0.05),no significant correlation with other recent and long-term complications(all P>0.05).Conclusion The incidence of pulmonary infection and anastomotic fistula in the right thoracic group are lower than those in the left thoracic group.CT could evaluate the common postoperative complications,and provide evidence for clinical active treatment directly and ac-curately.