多排螺旋CT检查在食管胃结合部腺癌术前评估中的应用价值  

Application value of multi-detector computed tomography examination in the preoperative assessment of adenocarcinoma of esophagogastric junction

作　　者：赵晓君[1] 周忠洁[1] 张弦[1] 刘锟[1] 严志汉[1] 

机构地区：[1]温州医科大学附属第二医院放射影像科,325027

出　　处：《中华消化外科杂志》2016年第11期1118-1122,共5页Chinese Journal of Digestive Surgery

基　　金：浙江省医药卫生科技项目（2014KYB159）

摘　　要：目的：探讨多排螺旋CT（MDCT）检查在食管胃结合部腺癌（AEG）术前评估中的应用价值。方法：采用回顾性横断面研究方法。收集2011年1月至2015年12月温州医科大学附属第二医院收治的91例AEG患者的临床病理资料。患者行MDCT平扫和增强扫描检查。完善术前相关检查后遵循患者及家属意愿行手术治疗，术后行病理学检查。采用门诊和电话方式进行随访。随访内容为肿瘤复发及转移情况。随访时间截至2015年12月。观察指标：（1）MDCT检查的影像学特征。（2）术前MDCT检查与术后病理学检查结果比较。（3）治疗及预后情况。正态分布的计量资料以±s表示。MDCT检查分期与病理学分期的一致性分析采用χ^2检验。结果：（1）MDCT检查的影像学特征：91例AEG患者腹部MDCT检查显示食管胃结合部管壁不均匀增厚，局部呈菜花状软组织肿块；增强检查呈明显不均匀强化，周围脂肪间隙清晰，肝胃之间多枚淋巴结肿大。（2）术前MDCT检查与术后病理学检查结果比较：91例AEG患者术前MDCT检查显示88例食管受侵犯，食管浸润长度为（3.1±1.1）cm。91A例AEG患者术后病理学检查显示：68例食管受侵犯，食管浸润长度为（3.5±1.3）cm。术前MDCT扫描检出食管受侵犯的敏感度为95.6%、特异度为85.0%、准确度为92.0%。术前MDCT检查判断浆膜受侵犯的敏感度为96.8%、特异度为84.2%、准确度为95.5%， κ=0.9。 91例AEG患者术前胃壁MDCT增强扫描检查显示：22例呈单层结构，69例呈多层结构（双层结构34例、3层结构35例）；术前MDCT检查AEG检出率为96.7%（88/91），其中T1、T2、T3、T4期分别为1、18、53、16例，假阴性3例。术后病理学检查显示：T1、T2、T3、T4期分别为2、17、55、17例。术前MDCT检查判断T分期的准确度为85.4%，κ=0.7。91例AEG患者术前MDCT增强扫描检查显示：N0、N1、N2、N3期分别为25、43、18、5�Objective：To investigate the application value of multidetector computed tomography （MDCT） examination in the preoperative assessment of adenocarcinoma of esophagogastric junction （AEG） . Methods：The retrospective crosssectional study was conducted. The clinicopathological data of 91 AEG patients who were admitted to the Second Affiliated Hospital of Wenzhou Medical University between January 2011 and December 2015 were collected. All the patients received plain and enhanced scans of MDCT, and they underwent operation under the consent of patients and his family members after preoperative relevant examinations and then received postoperative pathological examination. Followup using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis up to December 2015. Observation indicators included： （1） imaging features of MDCT, （2） comparison between preoperative MDCT examination and postoperative pathological examination, （3） treatment and prognosis. Measurement data with normal distribution were represented as ±s. Consistency analysis between stage of MDCT examination and pathological stage was done using the chisquare test.Results：（1） Imaging features of MDCT： MDCT findings in 91 AEG patients were heterogeneously thickened wall at esophagogastric junction and cauliflowerlike local soft tissue mass, and enhanced scan findings were obviously heterogeneous enhancement, clear periphery fat gap and most of lymph nodes enlargement between liver and stomach. （2） Comparison between preoperative MDCT examination and postoperative pathological examination： preoperative MDCT examination in 91 AEG patients showed that invasion of the esophagus was found in 88 patients, with a infiltration length of （3.1±1.1）cm. Postoperative pathological examination in 91 AEG patients showed that invasion of the esophagus was found in 68 patients, with a infiltration length of （3.5±1.3）cm. The sensitivity, specificity and accuracy of invasion of the e

关 键 词：食管胃结合部肿瘤 腺癌 Siewert分型 多排螺旋CT检查 

分 类 号：R735[医药卫生—肿瘤] R730.44[医药卫生—临床医学]