CT观察胸段食管癌气管食管沟淋巴结转移的临床意义探讨.pdf

中华放射学杂志2002年2月第36卷第2期ChinJRadiol,February2002,Vol36,No.2#139#

#胸部放射学#

CT观察胸段食管癌气管食管沟淋巴结转移的临床意义探讨

顾雅佳王玖华相加庆马龙飞

=摘要>目的评价CT对胸段食管癌伴两侧气管食管沟淋巴结的诊断价值及临床意义。方法
搜集经三野淋巴结清扫术的胸段食管癌病例46例,对照气管食管沟转移淋巴结的CT表现与病理改
变。结果46例病例中,14例有气管食管沟淋巴结转移,占30%。手术共取两侧气管食管沟淋巴结
277枚,病理证实淋巴结转移16枚,气管食管沟淋巴结转移与否与胸段食管癌部位及T分期无相关性
(P>0105)。CT诊断两侧气管食管沟淋巴结转移18枚,平均直径110cm(013~215cm)。CT检查发
现气管食管沟淋巴结个数的敏感性和特异性分别为87150%和98147%,阳性预测值77178%,阴性预
测值99123%。结论(1)对食管癌病人而言,气管食管沟处出现结节,即可认为是淋巴结转移。(2)
对不手术的放射治疗病人,下颈部及胸部CT检查应列为常规,并以此指导制订放疗计划。(3)胸段食
管癌两侧气管食管沟淋巴结清扫有临床意义,但如果CT显示两侧气管食管沟阴性,再加上临床检查
两侧下颈部颈内静脉淋巴结链区以及两侧锁骨上区淋巴结阴性者,可选择性不行三野清扫,以降低手
术并发症。
=关键词>食管肿瘤;淋巴转移;体层摄影术,X线计算机

AstudyonclinicalvalueofCTfeaturesoftracheoesophagealgroovelymphnodemetastasisofthoracic
esophagealcarcinomaGUYajia*,WANGJiuhua,XIANGJiaqing,MALongfei1*Departmentof
Radiology,theAffiliatedCancerHospitalofFuDanUniversity,Shanghai200032,China
=Abstract>ObjectiveToevaluatetheclinicalvalueofCTscaninthediagnosisoftracheoesophageal
groovelymphnode(TEGLN)metastasisofthoracicesophagealcarcinoma.MethodsForty-sixpatientswith
thoracicesophagealcarcinomaunderwentesophagectomywiththree-fielddissection(3FD)ofthecervical,
mediastinal,andabdominallymphnodes.CTfindingsofTEGLNwerecomparedwiththatofpathologicalfindings.
ResultsAmongthe46patientswhounderwentesophagectomywith3FD,14(30%)werefoundtohaveTEGLN
metastases.Ofthe277TEGLNsexcisedbyoperation,16werefoundtohavemetastases.Primarysitesofthe
thoracicesophagealcarcinomawithTEGLNmetastasisinupper,middle,orlowerportionwere66167%,
22186%,and40%,respectively.Thedifferencebetweeneachportionwasnotstatisticallysignificant.The

thoracicesophagealcarcinomawithTEGLNmetastasisinT1,T2,T3andT4stagingwere50.00%,25.00%,28.
57%,and100.00%,respectively.TherewasnostatisticallysignificantdifferencebetweeneachTstaging.18
TEGLNswerefoundinCTscans.Theaveragediameterofthemwas1cm(013~215cm).Sensitivityand
specificityofCTexaminationwere87.50%and98.47%,respectively.Positivepredictvalueandnegativepredict
valuewere77.78%and99.23%,respectively.ConclusionI