放疗后食管鳞癌术前CT扫描的价值

目的 评价CT在食管癌放疗后手术及TNM再分级中的作用.方法 回顾分析46例放疗后食管鳞癌患者手术前的CT资料与手术病理结果比较.对其中26例具有放疗前、后CT资料的患者,分别分析放疗前、后主动脉浸润、气管/支气管受累及淋巴结的变化.结果对放疗后食管鳞癌患者,CT对主动脉受侵判断的准确率、敏感性及特异性分别为82.50%、70.00%和86.67%;对气管/支气管受累判断分别为78.57%、88.89%及74.46%;对胸内阳性淋巴结转移的诊断分别为86.46%、66.67%及93.94%.与放疗前对照,放射治疗在降低食管鳞癌T分期方面有显著性差异,而胸内阳性淋巴结转移的改变没有明显差异. 结论 对放疗后手术前的患者,CT扫描有助于判断食管鳞癌对主动脉的侵犯、气管/支气管受累及胸内阳性淋巴结转移.术前放射治疗将减低食管鳞癌的T分期,但不会降低N分期.放疗后4～6周为较理想的CT检查和手术时间.

Efficacy of CT scanning before operation on esophageal squamous carcinoma and after radiotherapy

Objective To evaluate efficacy of CT scanning before operation on esophageal carcinoma and after radiotherapy, as well as in TNM re-grading. Methods CT scans of 46 patients with squamous cell esophageal carcinoma treated by pre-operative radiotherapy were retrospectively analyzed before operation in comparison with surgical pathological exam results. The aortic invasion, trachaobronchial invasion and lymphatic nodes involvement were assessed for those having CT data of both pre- and post- operation. Results The accuracy, sensitivity and specificity of CT assessment were as following: 82.50%, 70.00% , and 86.67% for aortic invasion; 78.57%, 88.89% and 74.46% for tracheobronchial invasion; 86.46%, 66.67% and 93.94% for lymph node involvement, respectively. The results showed that radiotherapy was able to significantly reduce T grading of the carcinoma, however no obvious effect on positive thoracic lymph node metastasis (N grading). Conclusion CT is very helpful in detecting aortic invasion, tracheobronchial inva- sion and lymph node involvement for esophageal squamous carcinoma, pre-operation radiotherapy was able to reduce T grading of the carcinoma but was futile in reducing N grading. 4-6 weeks later is an ideal moment for conducting CT scan and operation.