贲门癌术前16层螺旋CT检查对判断手术可行性的临床价值

目的评价术前16层螺旋CT检查对判断贲门癌手术可行性的临床价值。方法对58例贲门癌患者行术前双期增强16层螺旋CT扫描,再将CT图像进行多平面重建(MPR),依横断面图像和MPR图像观察肿瘤浸润深度、外浸范围、周围淋巴结转移情况,与手术中情况及术后病理结果对照,判断手术的可行性,并指导手术切除。结果58例贲门癌患者CT显示癌肿大小、浸润范围及肿大淋巴结,与术中所见基本吻合,术后病理证实皆为恶性。24例CT显示贲门肿块≤4.0 cm,与周围器官无粘联,未发现肿大淋巴结,全部行根治性切除手术。34例CT显示贲门肿块4.0~8.0 cm者,依其浸润程度和淋巴结转移情况,22例行根治性切除,10例行姑息切除,2例行探查术。结论术前16层螺旋CT检查有助于明确贲门癌原发肿瘤浸润深度、外浸范围和周围淋巴结转移情况,对判断手术可行性及指导手术切除具有重要的临床价值。

Clinical value of preoperative 16-slice spiral CT examination in judging the feasibility of the operation befor the operation of cardia cancer.

Objective: To appraise the clinical value of preoperative 16-slice spiral CT examination in judging the feasibility of the operation for cardia cancer.Methods: The double-phase 16-slice spiral CT enhanced scanning was conducted in 58 cases of the cardia cancer,then multiple plane reconstruction(MPR) was done on the CT images,and the cross-sectional images and the MPR images for the infiltration depth and invasion extent of the tumors and the situation of metabasis of lymph-gland surrounding it were observed.By contrasting with the situation in operation and the postoperative pathological result,the feasibility of the operation was judged to direct the excision in operation.Results: The size of the tumors,the infiltration depth and the intumescent lymph-gland shown by CT in the 58 cases of cardia cancer was fundamentally identical with those seen in the operation.After the operation the pathologies proved to be malignant.In 24 cases CT showed that the size of cardia tumor was less than or equal to 4.0 cm.There was no stick with surrounding organs and no intumescent lymph-gland was found.All were operated with radical excision.In 34 cases CT showed that the size of cardia tumor was between 4.0 and 0.8 cm.According to the infiltration degree and the situation of lymph-gland metabasis,the radical excision was conducted in 22 cases,the tentative excision using the news resection in 10 cases,and the explorative operation using exploration in 2 cases.Conclusion: The preoperative 16-slice spiral CT examination contributes to deciding the infiltration depth,invasion extent of the primary tumor of cardia cancer and the situation of metabasis of lymph-gland surrounding it,which has significant clinical value in judging the feasibility of operation and directing the excision in operation.