食管鳞状细胞癌术后淋巴结复发优势解剖分布与原发肿瘤解剖部位相关性的CT研究

CT characteristics and predominant distribution of lymph node recurrence secondary to postoperative esophageal squamous cell carcinoma

目的:探讨食管鳞状细胞癌术后淋巴结复发的优势解剖分布与原发肿瘤解剖部位相关性的CT研究。方法:选取263例确诊食管鳞状细胞癌患者为研究对象,所有病例均经手术切除病理证实为食管鳞状细胞癌,且所有病例均经病理证实或影像标准诊断有淋巴结复发。回顾性分析食管鳞状细胞癌术后淋巴结复发的位置、大小、形态、数目、强化特征及原发肿瘤术前解剖定位。结果:原发肿瘤解剖定位:胸上段59例,累及胸中段133例,累及胸下段71例。术后复发淋巴结解剖定位:263例患者术后淋巴结复发共361枚,其中胸上段共73枚,主要分布于锁骨上区(34.25%,25/73)、上纵隔(42.46%,31/73)(P<0.05);胸中段共197枚,主要分布于中纵隔(60.40%,119/197)(P<0.05);胸下段共91枚,主要分布于下纵隔(25.27%,23/91)、肝胃间隙及腹膜后(57.14%,52/91)(P<0.05)。食管鳞状细胞癌术后淋巴结复发CT特征:淋巴结肿大呈圆形(75.01%,271/361)、浅分叶(46.26%,167/361)、坏死融合(19.67%,71/361),增强扫描强化不均匀(37.40%,135/361)。结论:胸上段食管鳞状细胞癌术后淋巴结复发优势分布于锁骨上区及上纵隔,胸中段肿瘤术后淋巴结复发优势分布于中纵隔,胸下段肿瘤术后淋巴结复发优势分布于下纵隔及肝胃间隙及腹膜后。术后淋巴结复发的CT图像特征不仅有形态学上的变化,且增强扫描后强化方式呈不均匀强化。CT检查对于评价食管鳞状细胞癌术后淋巴结复发具有重要价值。

Objective:To investigate association between the predominant distribution of postoperative lymph node recurrence and the anatomic site of the primary tumor in esophageal squamous cell carcinoma with CT.Methods:A total of 263 patients with esophageal squamous cell carcinoma diagnosed were selected.All cases were pathologically confirmed as esophageal squamous cell carcinoma after surgical resection,and all cases had lymph node recurrence confirmed by pathology or imaging criteria.The location,size,morphology,number and enhancement of postoperative lymph node recurrence secondary to resected esophageal squamous cell carcinoma,as well as preoperative anatomical localization of the primary tumor were retrospectively analyzed.Results:Anatomical location of primary tumors:59 cases involved upper thoracic segment of esophagus,133 cases involved middle thoracic segment,and 71 cases involved lower thoracic segment.Anatomical location of recurrent lymph nodes after operation:A total of 361 recurrent lymph nodes were found in 263 patients.73 lymph nodes recurred in upper thoracic segment,and mainly distributed in the supravicular region(34.25%,25/73)and the upper mediastinum(42.46%,31/73)(P<0.05).197 lymph nodes recurred in middle thoracic segment,and mainly distributed in the middle mediastinum(60.40%,119/197)(P<0.05).91 lymph nodes recurred in lower thoracic segment,and mainly distributed in the lower mediastinum(25.27%,23/91),hepatogastric space and retroperitoneal group(57.14%,52/91)(P<0.05).CT features of postoperative lymph node recurrence due to the resected esophageal carcinomas showed round enlargement(75.01%,271/361),shallow lobulation(46.26%,167/361),necrotic fusion(19.67%,71/361),and uneven enhancement(37.40%,135/361).Conclusion:The lymph node recurrence due to the resected upper thoracic esophageal squamous cell carcinoma is predominantly located in supraclavicular region and upper mediastinum,the lymph node recurrence due to the resected middle thoracic tumor is predominantly located in middle mediastinum,and the lymph node recurrence due to the resected lower thoracic tumor is predominantly located in lower mediastinum,hepatogastric space and retroperitoneal spece.The CT features of postoperative lymph node recurrence not only showed morphological changes,but also uneven enhancement on enhanced scanning.CT examination has important application value in evaluating lymph node recurrence after the resection of esophageal squamous cell carcinoma.