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1、中華放射學(xué)雜志2002年2月第36卷第2期ChinJRadiol,February2002,Vol36,No.2#139##胸部放射學(xué)#CT觀察胸段食管癌氣管食管溝淋巴結(jié)轉(zhuǎn)移的臨床意義探討顧雅佳王玖華相加慶馬龍飛=摘要>目的評價CT對胸段食管癌伴兩側(cè)氣管食管溝淋巴結(jié)的診斷價值及臨床意義。方法搜集經(jīng)三野淋巴結(jié)清掃術(shù)的胸段食管癌病例46例,對照氣管食管溝轉(zhuǎn)移淋巴結(jié)的CT表現(xiàn)與病理改變。結(jié)果46例病例中,14例有氣管食管溝淋巴結(jié)轉(zhuǎn)移,占30%。手術(shù)共取兩側(cè)氣管食管溝淋巴結(jié)277枚,病理證實淋巴結(jié)轉(zhuǎn)移16枚,氣管食管溝淋巴結(jié)轉(zhuǎn)移與否與胸段食管癌
2、部位及T分期無相關(guān)性(P>0105)。CT診斷兩側(cè)氣管食管溝淋巴結(jié)轉(zhuǎn)移18枚,平均直徑110cm(013~215cm)。CT檢查發(fā)現(xiàn)氣管食管溝淋巴結(jié)個數(shù)的敏感性和特異性分別為87150%和98147%,陽性預(yù)測值77178%,陰性預(yù)測值99123%。結(jié)論(1)對食管癌病人而言,氣管食管溝處出現(xiàn)結(jié)節(jié),即可認(rèn)為是淋巴結(jié)轉(zhuǎn)移。(2)對不手術(shù)的放射治療病人,下頸部及胸部CT檢查應(yīng)列為常規(guī),并以此指導(dǎo)制訂放療計劃。(3)胸段食管癌兩側(cè)氣管食管溝淋巴結(jié)清掃有臨床意義,但如果CT顯示兩側(cè)氣管食管溝陰性,再加上臨床檢查兩側(cè)下頸部頸內(nèi)靜脈淋巴結(jié)鏈區(qū)以及兩
3、側(cè)鎖骨上區(qū)淋巴結(jié)陰性者,可選擇性不行三野清掃,以降低手術(shù)并發(fā)癥。=關(guān)鍵詞>食管腫瘤;淋巴轉(zhuǎn)移;體層攝影術(shù),X線計算機(jī)AstudyonclinicalvalueofCTfeaturesoftracheoesophagealgroovelymphnodemetastasisofthoracic**esophagealcarcinomaGUYajia,WANGJiuhua,XIANGJiaqing,MALongfei1DepartmentofRadiology,theAffiliatedCancerHospitalofFuDanUnivers
4、ity,Shanghai200032,China=Abstract>ObjectiveToevaluatetheclinicalvalueofCTscaninthediagnosisoftracheoesophagealgroovelymphnode(TEGLN)metastasisofthoracicesophagealcarcinoma.MethodsForty-sixpatientswiththoracicesophagealcarcinomaunderwentesophagectomywiththree-fielddissect
5、ion(3FD)ofthecervical,mediastinal,andabdominallymphnodes.CTfindingsofTEGLNwerecomparedwiththatofpathologicalfindings.ResultsAmongthe46patientswhounderwentesophagectomywith3FD,14(30%)werefoundtohaveTEGLNmetastases.Ofthe277TEGLNsexcisedbyoperation,16werefoundtohavemetastas
6、es.PrimarysitesofthethoracicesophagealcarcinomawithTEGLNmetastasisinupper,middle,orlowerportionwere66167%,22186%,and40%,respectively.Thedifferencebetweeneachportionwasnotstatisticallysignificant.ThethoracicesophagealcarcinomawithTEGLNmetastasisinT1,T2,T3andT4stagingwere5
7、0.00%,25.00%,28.57%,and100.00%,respectively.TherewasnostatisticallysignificantdifferencebetweeneachTstaging.18TEGLNswerefoundinCTscans.Theaveragediameterofthemwas1cm(013~215cm).SensitivityandspecificityofCTexaminationwere87.50%and98.47%,respectively.Positivepredictvaluea
8、ndnegativepredictvaluewere77.78%and99.23%,respectively.ConclusionInpatientwiththoracicesophagealcarcino
