体表超声对腹段食管癌浸润深度的诊断价值

Evaluation on invasion depth of distal esophageal carcinoma with transabdominal ultrasound

目的 分析总结腹段食管癌壁层结构形态变化的声像图表现 ,并与手术病理对照 ,探讨经体表超声对腹段食管癌浸润深度的诊断价值。方法 根据体表超声显示的胸下段及腹段食管 (以下简称食管 )肿瘤的壁层结构及外膜强回声线的连续性、与邻近脏器的分界 ,以及患者深呼吸运动状态食管移动性的附加方法等 ,判断食管肿瘤的浸润深度。超声诊断标准为 :肿瘤区食管外膜强回声线显示连续、平整 ,食管随呼吸移动良好为外膜未受侵 (S1) ;外膜强回声线不平整或中断 ,食管移动尚可为食管外膜受侵 (S2 ) ;肿瘤与邻近脏器组织分界不清 ,呼吸运动受限或消失为邻近脏器受侵 (S3 )。对 89例食管癌及食管贲门癌进行超声与手术病理的对比研究。结果 病理诊断S1、S2、S3者 ,超声测量食管壁厚度分别为 0 .4～ 4.3cm、0 .5～ 2 .1cm、0 .9～ 3 .2cm ;壁厚测量与浸润深度密切相关 (P <0 .0 0 5 ;列联系数 =0 .8)。超声诊断S1、S2、S3的灵敏性分别为 46.2 %(6/13例 )、 80 .0 %(4 8/60例 )、62 .5 %(10 /16例 ) ,诊断困难占 5 .6%(5 /89例 ) ,诊断正确率达 71.9%(64 /89例 )。结论 体表超声对食管癌壁浸润深度可作出一定程度的判断 ,尤其对肿瘤侵及食管外膜及邻近肝脏受侵的诊断率较高 ,可作为食管癌术前的辅助诊断方法。

Objective To summarize ultrasonographic manifestations of distal esophageal carcinoma compared with surgical and pathological findings,and investigate the diagnostic role of transabdominal ultrasound in evaluation of invasion depth of distal esophageal carcinoma. Methods Criteria on invasion depth of distal esophageal carcinoma by transabdominal ultrasound were as follows: intramural hypoechoic tumor with continuous smooth hyperechoic line of adventitia and free movement of esophagus with breath were considered as S1;incontinuous or interrupted hyperechoic line of adventitia and relatively poor movement of esophagus with breath were considered as S2;unclear boundaries of tumor with adjacent structures and poor or no relative movement with breath,S3. S1,S2,S3 referred to those without or with adventitia invasion or invasion to adjacent structures,respectively. Eighty-nine esophageal carcinoma and esophageal-cardiac junction carcinoma were enrolled in our study and retrospectively studied compared with surgical and pathological findings. Results For tumors of S1,S2,S3,the thickness of the esophageal wall were 0.4 - 4.3 cm, 0.5 - 2.1 cm, 0.9 - 3.2 cm,respectively. Thickness of the esophageal wall was significantly related with invasion depth ( P < 0.005 ;Persion index= 0.8 ). Sensitivity of transabdominal ultrasound was 46.2 % (6/13 cases),80.0% (48/60 cases), 62.5 % (10/16 cases) respectively for tumors of S1,S2,S3. Five cases ( 5.6 %) were difficult to assess by transabdominal ultrasound. Overall diagnostic accuracy was 71.9 % (64/89 cases). Conclusions Transabdominal ultrasound plays an important role in identification of invasion depth for distal esophageal carcinomas,especially those invasions to adjacent structures. It is helpful in preoperative evaluation of tumor as a complemental method.