内镜超声联合CT对纵隔镜下食管癌根治性切除术的临床价值

Value of Endoscopic Ultrasonography Combined with CT in Choice of Mediastinoscopic Radical Resection of Esophageal Cancer

背景:纵隔镜是治疗早期食管癌的有效方法,具有创伤小、风险低的特点。食管癌术前准确分期是选择纵隔镜治疗的关键。目的:探讨内镜超声(EUS)联合CT对纵隔镜下食管癌根治性切除术的临床价值。方法:对60例食管癌患者分别行EUS和CT术前分期,并与术后病理结果进行比较。将患者分为纵隔镜组和常规手术组,比较两组手术时间、术中出血量、术后胸腔引流量、术后住院时间。结果:术前EUS检查对T、N分期的准确率分别为81.7%和83.3%;术前CT检查分别为60.0%和53.3%;EUS联合CT检查分别为85.0%和86.7%。与常规手术组相比,纵隔镜组术中出血量[(178.2±30.1)m L对(232.0±48.2)m L,P<0.05]、术后胸腔引流量[(142.8±22.5)m L对(256.0±42.3)m L,P<0.01]、术后住院时间[(12.1±2.5)d对(14.3±3.6)d,P<0.05]均明显降低,两组手术时间无明显差异[(152.4±13.2)min对(163.3±25.5)min,P>0.05]。结论:EUS联合CT检查能提高食管癌术前分期的准确率,从而为纵隔镜治疗食管癌提供重要参考价值。

Background: Mediastinoscopy is an effective method for the treatment of early esophageal cancer with minimal invasiveness and lower risk. Preoperative accurate staging of esophageal cancer is the key for the choice of mediastinoscopic operation as the treatment modality. Aims: To evaluate the value of combination of endoscopic ultrasonography( EUS) with CT for the treatment of esophageal cancer under mediastinoscopy. Methods: Sixty patients with esophageal cancer were enrolled. The TN staging results of esophageal cancer by EUS and CT examination were compared with the results of postoperative TN staging. Patients were divided into mediastinoscopic operation group and conventional operation group,and the operation time,intraoperative bleeding volume,postoperative pleural drainage flow and postoperative hospitalization time of the two groups were compared. Results: The accuracy rates of preoperative EUS examination in assessing T and N stage were 81. 7% and 83. 3%,respectively; accuracy rates of preoperative CT examination were 60. 0% and 53. 3%,respectively; and accuracy rates of EUS combined with CT were 85. 0% and 86. 7%,respectively. Compared with conventional operation group,intraoperative bleeding volume [( 178. 2 ± 30. 1) m L vs.( 232. 0 ± 48. 2) m L,P < 0. 05],postoperative pleural drainage flow [( 142. 8 ± 22. 5) m L vs.( 256. 0 ± 42. 3) m L, P < 0. 01 ], postoperative hospitalization time [( 12. 1 ± 2. 5) days vs.( 14. 3 ± 3. 6) days,P < 0. 05] in mediastinoscopic operation group were significantly decreased,and no significant difference in operation time was found between the two groups [( 152. 4 ± 13. 2)minutes vs.( 163. 3 ± 25. 5) minutes,P > 0. 05]. Conclusions: Combination of EUS with CT examination can improve the accuracy of preoperative staging,thus provides an important reference for the choice of treating esophageal cancer by mediastinoscopic operation.