期刊文献+

CT扫描确定胸中段食管癌手术入路 被引量:4

Operative approach in patients with carcinoma of the middle third of esophagus determined by preoperative CT scan
下载PDF
导出
摘要 目的:探讨术前CT扫描确定胸中段食管癌手术入路的意义。方法:选择87例胸中段食管癌患者行术前胸部强化CT扫描检查(观察组),根据CT结果确定手术路径:若肿瘤与主动脉关系密切选择经左胸手术;若肿瘤侵犯奇静脉,选择Ivor-Lewis路径;其余患者根据纵隔淋巴结转移确定手术路径。另选择同期术前未行CT扫描检查、常规行Ivor-Lewis手术的118例胸中段食管癌患者为对照组。采用χ2检验及t检验比较两组肿瘤切除率及阳性淋巴结率的差别。结果:CT扫描对N分期的敏感度为74.7%(65/87),特异度为60%(39/65)。CT诊断肿瘤侵犯主动脉的敏感度为21.8%(19/87),特异度为26.3%(5/19)。观察组的肿瘤切除率为92%,对照组为81.4%,两者差异显著(P<0.05)。观察组清扫淋巴结15±2.46个,对照组清扫12±1.75个,差别无统计学意义(P>0.05)。清扫的淋巴结中,观察组的阳性淋巴结占63.2%,对照组占52.6%,两者差别显著(P<0.05)。结论:对胸中段食管癌患者可采用Ivor-Lewis手术,但若术前CT扫描有明显主动脉受侵犯或(和)左侧淋巴结转移为主时,应经左胸路径施行手术,以期提高肿瘤根治切除率。 Purpose:To explore the rational operative approach in patients with carcinoma of the middle third of the esophagus by T and N status as determined by preoperative CT scan. Methods:87 cases with carcinoma of the middle third of the esophagus chosen for the operative approach by CT findings entered the observational group, 118 cases with carcinoma of the middle third of the esophagus who were not scanned by CT were put into the control group. The observational group adopted different operative approaches by the relationship between the primary tumour and the aorta,and the relationship between the primary tumour and the azygos vein,and by the metastasis of regional lymph nodes. The operative approaches were chosen as follows:if the aorta was not involved, the operative approaches were chosen by the metastastatic status of the regional lymph nodes; left thoracoabdominal approaches were chosen,if the aorta was involved,and Ivor-Lewis operation was involved if the azygos vein was involved.The control group adopted the Ivor-Lewis operation. The rate of resection between two groups and the difference in positivity rates of the resected regional lymph node were analysed by chi-square test and T test. Results:Sensitivity of N staging by CT scan was 74.7%(65/87), and specificity of N staging was 60%(39/65). Sensitivity of diagnosis of the aorta involved by tumour by CT scan was 21.8%(19/87), and specificity was (26.3%)(5/19). The rate of resection in the observational group was 92%, and the rate of resection in the control group was'81.4%. Both were markedly different,P<0.05, The comparison of the resected regional lymph node between the two groups was also significant,P<0.05. Conclusions:Ivor-Lewis operation was routinely chosen to treat the patients with carcinoma of the middle third of esophagus , except for cases whose tumours involved the aorta and/or involvement of left lymph nodes by CT scan,then the latter was treated by left thoracoabdominal approach or left thoracoabdominal cervical approach.
出处 《中国癌症杂志》 CAS CSCD 2005年第2期181-184,共4页 China Oncology
关键词 食管癌 CT 手术入路 esophageal carcinoma operation approach CT
  • 相关文献

参考文献15

  • 1郭昭扬,俞力超,徐新华,许运龙.胸段食管癌颈部及上纵隔淋巴结转移[J].中华胸心血管外科杂志,1999,15(1):18-19. 被引量:19
  • 2王洲,刘相燕,刘凡英,陈景寒.N_0期食管癌术后早期复发与淋巴结微转移的相关性研究[J].中华外科杂志,2004,42(2):68-71. 被引量:45
  • 3Kato H, Tachimori Y, Watomabe H, et al. Lymph node metastasis in thoracic esophageal carcinoma[ J]. J Surg Oncol, 1991,48(2) :106-107.
  • 4邵令方.食管及贲门恶性肿瘤[A].顾恺时.顾恺时胸心外科手术学[M].上海:上海科学技术出版社,2003/9(2).946-947.
  • 5Page RD, Khalil JE, Whyte RI, et al. Esophagogastrectomy via left thoracophrenotomy [ J ] . Ann Thorac Surg, 1990,49 (5) :763 .
  • 6Visbal AL,Allen MS ,Miller DL ,et al . Ivor Lewis esophagogastrectomy for esophageal cancer[ J] . Ann Thorac Surg,2001,71(6) :1803-1808 .
  • 7Tabira Y, Okuma T, Kondo k, et al . Indications for three-field dissection followed by esophagectomy for carcinoma of the thoracic esophagus [ J ]. J Thorac Cardiocasc Surg,1999,117 ( 2 ): 239-245.
  • 8Rice TW . Clinical staging of esophageal carcinoma CT 、 EUS and PET [ J ]. Chest Surg Clin N Am,2000,10 ( 3 ) :471-485.
  • 9Heidemann J,Schilling MK,Schmassmann A, et al. Accuracy of endoscopic ultrasonography in preoperative staging of esophageal carcinoma [J]. Dig Surg,2000,17(3) :219-224.
  • 10Lightdale CJ . positron emission tomography: another useful test for staging esophageal cancer [ J ] . J Clin Oncol,2000,18 ( 17 ):3199-3201.

二级参考文献20

  • 1曹子昂 毛君琪.国际癌分期标准[M].上海:上海科学技术文献出版社,1994.85-87.
  • 2邵冲 叶玉坤 等.食管上段癌与淋巴结转移[J].中华胸心血管外科杂志,1994,10:245-247.
  • 3戎铁华 林鹏 等.胸段食管癌淋巴结转移的临床研究[J].中华胸心血管外科杂志,1994,10:242-244.
  • 4曹子昂(译),国际癌分期标准,1994年,62页
  • 5戎铁华,中华胸心血管外科杂志,1994年,10卷,242页
  • 6邵冲,中华胸心血管外科杂志,1994年,10卷,245页
  • 7Martini N, Bains MS, Burt ME, et al. Incidence of local recurrence and secondary primary tumors in resected stage I lung cancer[J]. J Thorac Cardiovasc Surg, 1995, 109 (1):120
  • 8Ohgami A, Mitsudomi T, Sugio K, et al. Micrometastatic tumor cells in the bone marrow of patients with non-small cell lung cancer[J]. Ann Thorac Surg, 1997, 64(2) :363
  • 9Passlick B, Kubuschok B, Izbicki JR, et al. Isolated tumor cells in bone marrow predict reduced survival in node-negative non-small cell lung cancer[J]. Ann Thorac Surg, 1999, 68(6) :2053
  • 10Passlick B, Izbicki JR, Kubuschok B, et al. Detection of disseminated lung cancer cells in lymph nodes: impact on staging and prognosis[J]. Ann Thorac Surg, 1996, 61(1): 177

共引文献67

同被引文献21

引证文献4

二级引证文献18

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部