摘要
目的探讨螺旋CT在食管癌手术可行性与预后评估中的运用价值。方法选择2019年2月至2020年4月高州市中医院收治的120例食管癌患者为研究对象,术前均行螺旋CT检查,然后将胸段食管癌对心包、胸主动脉以及气管、支气管的浸润程度作为基本依据,术前将食管癌分为姑息切除型、难切除型以及易切除型,并根据手术、病理结果,分析螺旋CT检查的准确性。结果术前经螺旋CT检查,所有患者均可行手术切除治疗,但实际上行手术切除114例,评估准确率为95.00%,其中14例为姑息切除型、35例为难切除型、65例为易切除型,其余6例由于肿瘤侵犯邻近组织而仅行探查术,术前诊断阴性3例,认为能够切除,但是术中见肿瘤包绕奇静脉、肺静脉,且侵及支气管,形成食管气管瘘;根据手术病理检查结果,螺旋CT单纯横断面图像诊断食管癌入侵的阴性预测值、阳性预测值、准确性、特异度以及敏感度分别为88.89%、84.21%、86.67%、86.15%、87.27%;而螺旋CT多平面重组+横断面图像则为91.18%、94.23%、92.50%、95.38%、89.09%,差异无统计学意义(P>0.05);同时,经手术病理检查,20例为T1期、25例为T2期、48例为T3期、27例为T4期,而螺旋CT诊断T1~T4期食管癌的准确率分别为75.00%(15/20)、84.00%(21/25)、93.75%(45/48)、92.59%(25/27),总准确率为88.33%(106/120);经Kappa一致性检验,结果显示手术病理检查与术前螺旋CT具有较好的一致性(kappa=0.761,P<0.001)。结论对于食管癌患者,术前通过行螺旋CT检查,可将食管肿瘤与周围结构的关系直观显示出来,并且可以对病变食管壁的长度、厚度、与周围气管、支气管的形态以及与主动脉接触角度等多项CT指标进行综合评价,不仅可以判断食管癌是否可切除,还能为选择合理的术式提供有效依据,值得推广。
Objective To explore the application value of spiral CT in evaluating the feasibility of resection of esophageal carcinoma(EC)and prognosis.Methods A total of 120 EC patients admitted to Gaozhou Hospital of Traditional Chinese Medicine from February 2019 to April 2020 were selected as research subjects.All patients underwent spiral CT before operation.Based on the infiltration degree of thoracic EC to pericardium,thoracic aorta and tracheal bronchus,EC was classified into palliative resection type,difficult resection type and easy resection type before operation,and the accuracy of spiral CT examination was analyzed according to the results of operation and pathology.Results After preoperative multi-slice spiral CT examination,all patients could be treated with the resection of EC.Actually,114 cases received resection surgery,with an accuracy rate of 95.00%,of which 14 cases were palliative resection type,35 cases were difficult resection type and 65 cases were easy resection type.The other 6 cases only received exploratory surgery owing to the tumor invading the adjacent tissues.3 cases diagnosed as negative before surgery were considered to be resectable.However,intraoperatively,the tumors were seen to encircle azygos vein and pulmonary vein and to have invaded the bronchus,forming an esophagotracheal fistula.According to the results of pathological examination,the negative predictive value,positive predictive value,accuracy,specificity and sensitivity of spiral CT in the diagnosis of esophageal cancer invasion were 88.89%,84.21%,86.67%,86.15% and 87.27%;and spiral CT multi-plane reconstruction+cross-sectional image was 91.18%,94.23%,92.50%,95.38%,89.09%,the difference was not statistically significant(P>0.05);Meanwhile,according to the pathological examination,20 cases were in T1 stage,25 cases were in T2 stage,48 cases were in T3 stage and 27 cases were in T4 stage.The accuracy rate of multi-slice spiral CT was 75.00%(15/20),84.00%(21/25),93.75%(45/48)and 92.59%(25/27),respectively,in diagnosing EC from T1 to
作者
卢壬肖
LU Renxiao(Department of Imaging,Gaozhou Hospital of Traditional Chinese Medicine,Guangdong,Gaozhou 525200,China)
出处
《中国医药科学》
2022年第5期151-155,共5页
China Medicine And Pharmacy
基金
广东省茂名市科技计划项目(210316194550536)。
关键词
螺旋CT
食管癌
可行性
手术
Spiral CT
Esophageal carcinoma
Feasibility
Surgery