食管癌术前CT检查的临床意义

Clinical significance of preoperative CT examination for esophageal carcinoma

目的 探讨食管癌手术前CT检查的临床意义。方法 对 10 7例食管癌病人于手术前 2周行CT检查 ,根据三角脂肪间隙 (食管、主动脉、椎体三者围成的三角间隙 )的变化、食管肿块与主动脉间低密度区 (线 )存在或消失 <、≥ 3个CT层面分为A、B、C三组。另按食管肿瘤与气管、支气管有无粘连及气管有无增厚分为 3组 :a组为无粘连 76例 ,b组为有局限性粘连 2 0例 ;c组为有局限性增厚 11例。并对各组手术切除率及术中探查情况进行对比分析。结果 A、B、C三组手术切除率分别为 10 0 % ( 5 5 /5 5 )、91.6 % ( 2 2 /2 3)、6 8.9% ( 2 0 /2 9) ,分离率分别为 10 0 % ( 5 5 /5 5 )、91.6 % ( 2 2 /2 3)、6 .89% ( 2 /2 9)。a、b、c三组分离率分别为 10 0 % ( 76 /76 )、95 % ( 19/2 0 )、18.2 % ( 2 /11)。结论 食管癌手术前行CT检查 ,根据三角间隙、低密度区 (线 )消失的长度、有无气管、支气管壁粘连及局限性增厚等指标综合判断 ,可提高食管癌手术切除率。

Objective To study the clinical significance of preoperative examination for esophageal carcinoma. Methods 107 patients with esophageal carcinoma were given CT examination two weeks before operation. All the patients were allocated to three groups (Group A, B and C) according to the changes of triangular fat space (triangular space surrounded by esophagus, aorta and vertebral body), esophageal tumor, and the low-density area within aorta which existing or disappeared <, ≥3 CT layers. Besides, they were divided into another three groups (Group a, b and c ) according to the indexes of esophageal neoplasm were adhesion to the trachea, bronchus or not, and the trachea had pachynsis or not: Group a of 76 cases had no adhesion, Group b of 20 cases had localized adhesion; Group c of 11 cases had localized pachynsis. The excision rate and the intraoperative exploration condition were comparatively analyzed between the groups. Results The excision rates in Group A, B and C were 100% (55/55), 91.6% (22/23), and 68.9% (20/29), respectively, and the separation rates were 100% (55/55), 91.6% (22/23) and 6.89% (2/29), respectively. The separation rates in Group a, b and c were 100% (76/76), 95% (19/20) and 18.2% (2/11), respectively. Conclusions The excision rate for carcinoma of esophagus could be increased by preoperative CT examination and the comprehensive judgment by the indexes of triangular space, existence or disappeared length of the low density area (lines), with or without adhesion of trachea or bronchi, and the localized pachynsis.