食管胃结合部腺癌浸润范围的影像学评价  

Radiological evaluation on invasive extent of adenocarcinoma of esophagogastric junction

作　　者：唐磊[1] 李佳铮 Tang Lei;Li Jiazheng(Department of Radiology,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室医学影像科,100142

出　　处：《中华胃肠外科杂志》2019年第2期119-125,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81371715);首都临床特色应用研究与成果推广(Z161100000516060);北京市医管局青苗计划(QML20161102).

摘　　要：影像学对食管胃结合部腺癌侵犯上下界的准确判断,可为外科手术方式及分期标准的选择提供帮助.应用的主要检查手段包括X线气钡双对比造影、CT和MRI。规范化前处置,联合应用双对比及流动涂抹法等多种对比手段,配合常规正位、左右前斜及卧位右后斜等多角度观察,可提高X线气钡双对比造影对食管受侵长度和胃浸润中心点的判断准确性。腹部增强CT是目前临床指南推荐的食管胃结合部腺癌首选影像学检查手段。CT多平面重组图像测量或公式计算法联合评估肿瘤中心点距2 cm线的相对位置。"三层四分法"分型可为胸腹联合术式的选择提供参考。沿食管至胃腔走行画线获得CT曲面重建图像,可直观显示病变延伸范围。磁共振多序列联合有助于病变范围的判断。未来需更多影像学研究制定准确率、可重复性高且操作简便的判断标准,为临床食管胃结合部腺癌的侵犯范围评估提供帮助。The accurate judgement of the upper and lower borders of the adenocarcinoma of esophagogastric junction (AEG)by radiology can facilitate the decisions on surgical approach and staging criteria.X-ray double contrast radiography,CT and MRI are the common modalities.The accuracy of X-ray double contrast radiography in determining the invasion length of esophagus and the central point of gastric infiltration can be improved by standardized pretreatment, combination of muhiple contrast methods such as double contrast and flow-coating procedure,and combination of multi- angle observations such as conventional frontal,left/right anterior oblique and supine right posterior oblique position. Abdominal enhanced CT is the imaging method recommended by clinical guidelines for the radiological examination of AEG. The relative position of the central point of the tumor from 2 cm line can be determined through the combination of measurement and formula calculation on multi-planar reconstructed CT images.The "three-layer four-type"classification can provide reference for the selection of abdominothoracic incision.The direct demonstration of the tumor extension can be achieved through the CT curved planar reconstruction by drawing lines along esophagus to stomach.The combination of multiple sequences of MRI is helpful to determine the extension of the lesions.In the future,more radiological studies are needed to establish criteria with high accuracy,repeatability and convenient operation,and to assist clinical evaluation of AEG invasion.

关 键 词：食管胃结合部腺癌 肿瘤浸润范围 影像学 

分 类 号：R735[医药卫生—肿瘤]