可切除性食管鳞状细胞癌淋巴结转移特征与原发肿瘤解剖部位关系的多层螺旋CT研究

Study of the relationship between characteristics of lymph node metastasis and anatomical site of primary tumor in resectable esophageal squamous cell carcinoma by multi-slice spiral CT

目的:探讨不同解剖部位食管鳞状细胞癌淋巴结转移特征的CT表现。方法:选取经手术确诊的96例食管鳞状细胞癌伴淋巴结转移患者为研究对象,回顾性分析患者的临床表现及转移淋巴结的CT特征,并通过多层螺旋CT分析食管癌病变部位与不同区域淋巴结转移的关系。结果:胸上段食管鳞状细胞癌淋巴结转移常见于颈部及上纵隔淋巴结,胸中段食管鳞状细胞癌淋巴结转移常见于上、中纵隔淋巴结,胸下段食管鳞状细胞癌淋巴结转移常见于下纵隔及胃周淋巴结(P<0.0001)。胸上段食管鳞状细胞癌喉返神经旁淋巴结转移率高于胸中、下段(P=0.005)。结论:食管鳞状细胞癌不同病变部位各有其常见的淋巴结转移区域,其中胸上段食管鳞状细胞癌上纵隔淋巴结中以喉返神经旁淋巴结转移最为常见,多层螺旋CT则有助于术前准确评估。

Objective:To investigate the CT findings of lymph node metastasis of esophageal squamous cell carcinoma at different anatomical sites.Methods:96 patients with esophageal squamous cell carcinoma with lymph node metastasis diagnosed by operation were enrolled into our study.The clinical manifestations and CT characteristics of metastatic lymph nodes were reviewed retrospectively.The relationship between lesion location of esophageal carcinoma and lymph node metastasis in different regions was statistically analyzed by multi-slice spiral CT.Results:Lymph node metastasis of upper thoracic esophageal squamous cell carcinoma was common in cervical and upper mediastinal lymph nodes,lymph node metastasis of middle thoracic esophageal squamous cell carcinoma was common in upper and middle mediastinal lymph nodes,and lymph node metastasis of lower thoracic esophageal squamous cell carcinoma was common in lower mediastinal and perigastric lymph nodes(P<0.0001).The metastasis rate of pararecurrent laryngeal lymph nodes in upper thoracic esophageal squamous cell carcinoma was higher than that in middle and lower thoracic esophageal squamous cell carcinoma(P=0.005).Conclusion:Esophageal squamous cell carcinomasat different lesion sites have their common lymph node metastasis areas.Among the upper mediastinal lymph nodes of esophageal squamous cell carcinoma in the upper thoracic segment,the lymph node metastasis near the recurrent laryngeal nerve is the most common.Multi-slice spiral CT is helpful for accurate preoperative evaluation.