超声内镜在食管原发肿瘤放射治疗定位中的价值研究  

Endoscopic ultrasonography for defining primary tumor in esophageal radiotherapy

作　　者：裘国勤[1] 杜向慧[1] 俞江平[2] 陶亚利[2] 郑远达[1] 罗浩杰[1] 许亚萍[1] 陈建祥[1] 孙晓江[1] 季永领[1] 

机构地区：[1]浙江省肿瘤医院放疗科胸组,杭州310022 [2]浙江省肿瘤医院内镜中心,杭州310022

出　　处：《中华消化内镜杂志》2011年第1期17-20,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的 探讨胸段食管鳞癌基于超声内镜检查（EUS）和基于CT勾画的大体肿瘤靶体积（GTVEUS、GTVCT）的差异.方法 2008年3月到2010年2月间连续收治的36例胸段食管鳞癌患者CT模拟定位前行EUS,在EUS确定的食管病变上下界用止血夹标记.治疗体位CT模拟定位,在定位CT片上勾画GTVCT和根据止血夹标记勾画GTVEUs.分别对纵向GTVCT和纵向GTVEUS长度（LCT、LEus）和空间位置差异进行比较.结果 LCT为（7.79±3.15）cm,LEUS为（7.42±2.72）cm,两者比较差异无统计学意义（t=0.82,P＞0.05）,两者Pearson相关系数为0.61（P＜0.001）.2例CT无法显示病变部位,故对其余34例进行空间位置差异比较：纵向GTVCT与纵向GTVEUS空间位置吻合度（CI）为0.79±0.18,71%（24/34）患者两者空间位置不一致.8例近端不一致,21例远端不一致.未发现与EUS放置止血夹有关的并发症.结论 超声内镜止血夹定位术安全、可靠.在胸段食管鳞癌（尤其是在浅表生长的肿瘤和黏膜下生长的肿瘤）纵向GTV定位中,超声内镜能够为CT提供额外信息.Objective To investigate the differences of measurement of gross target volume （GTV）between endoscopic ultrasonography （ EUS ）-based （ GTVEUS ） and computed tomography （ CT ） -based （GTVCT） method for thoracic esophageal squamous cell carcinoma. Methods EUS was performed on 36consecutive patients with thoracic squamous cell carcinoma, and the superior and inferior boarders of the tumor defined by EUS were marked with hemoclips. The CT planning scan was then performed with the patient in supine position, and the GTVCT and GTVEUS were contoured respectively. The lengths （ LCT and LEUS） and spatial locations of longitudinal GTVCT and GTVEUS were compared. Results The mean LCT and LEUS were （7. 79 ± 3. 15 ） cm and （7. 42 ± 2. 72） cm, respectively （ t = 0. 82, P 〉 0. 05 ）, with a correlation coefficient of 0. 61 （P 〈0. 001 ）. Locations of longitudinal GTVCT and GTVEUS were compared in 34cases, with 2 excluded for invisualization on CT. The mean conformal index （CI） was （0. 79 ± 0. 18 ）, and spatial variations were found in 71% patients, with 8 patients at proximal end and 21 others at distal end.There was no clip placement associated complication. Conclusion Endoscopic hemoclips placement is safe and reliable. EUS can provide additional information to CT in defining longitudinal GTV in thoracic esophageal squamous cell carcinoma, especially in superficial and submucosal carcinomas.

关 键 词：食管肿瘤 腔内超声检查 体层摄影术 X线计算机 大体肿瘤靶体积 止血夹 

分 类 号：R735.1[医药卫生—肿瘤]