术前螺旋CT增强扫描对胸中段食管癌患者手术入路选择的指导意义分析

Guiding Significance of Preoperative Spiral CT Enhanced Scan in the Choice of Surgical Approach for Patients with Middle Thoracic Esophageal Cancer

目的探讨术前螺旋CT增强扫描对胸中段食管癌患者手术入路选择的指导意义。方法收集2018年6月至2019年6月于我院接受手术治疗的90例胸中段食管癌患者,术前常规进行胸部螺旋CT增强扫描以判断肿瘤切除可能性,评估肿瘤侵犯程度及淋巴结转移情况,指导手术入路选择。以术后病理检查结果为“金标准”,评估术前螺旋CT对肿瘤外侵(主动脉、下肺静脉、心包、气管/支气管)、淋巴结转移的诊断价值,记录手术入路及淋巴结清扫结果。结果术前螺旋CT诊断主动脉、下肺静脉、心包、气管/支气管受侵犯的敏感性分别为77.78%、75.00%、80.00%、75.00%,诊断淋巴结转移的敏感性为69.39%;82例患者完成根治手术,其中左胸手术55例,右胸手术27例,每例患者清扫淋巴结6~70枚,平均清扫淋巴结17.49枚,全组清扫淋巴结总数为1652枚;术前螺旋CT提示,7例患者上纵隔淋巴结可疑转移改为经右胸入路,5例患者食管壁无明显增厚、无明显淋巴结肿大改为左胸手术,6例患者肿瘤侵犯邻近组织器官,分别选择对术野暴露充分的手术入路。结论术前螺旋CT增强扫描对肿瘤侵犯和淋巴结转移有较好的诊断价值,有助于手术入路的个体化选择。

Objective To explore the guiding significance of preoperative spiral CT enhanced scan in the choice of surgical approach for patients with middle thoracic esophageal cancer.Methods Ninety patients with middle thoracic esophageal cancer who underwent surgery from June 2018 to June 2019 in our hospital were enrolled.A preoperative routine chest CT scan was performed to determine the possibility of tumor resection,assess the tumor invasion degree and lymph node metastasis,and guide the choice of surgical approach.The postoperative pathological findings were used as the gold standards to evaluate the diagnostic value of preoperative spiral CT on tumor invasion(aorta,inferior pulmonary vein,pericardium,trachea/bronchus)and lymph node metastasis.In addition,the surgical approach and lymph node dissection were recorded.Results The sensitivities of preoperative spiral CT in diagnosing aortic,inferior pulmonary vein,pericardium,and tracheal/bronchial invasion were 77.78%,75.00%,80.00%and 75.00%,respectively.The sensitivity of diagnosis of lymph node metastasis was 69.39%.In addition,82 patients completed radical surgery,including 55 cases of left thoracic surgery and 27 cases of right thoracic surgery.Each patient had 6 to 70 dissected lymph nodes with an average of 17.49,and the total number of lymph nodes in the whole group was 1652.Preoperative spiral CT showed that 7 patients had suspicious upper mediastinal lymph nodes metastases were changed to the right thoracic approach and 5 patients without apparent thickening of the esophageal wall and obvious lymphadenectasis were changed to left thoracic surgery,and 6 patients with tumor invasion of adjacent tissues and organs were given surgical approaches of the fully exposed operative field.Conclusion Preoperative spiral CT enhanced scan has an excellent diagnostic value on tumor invasion and lymph node metastasis and contributes to the individualized choice of surgical approach.