食管入口病变的X线钡剂和CT检查及其临床意义

目的：分析食管入口病变的临床以及X线和CT表现，探讨食管入口病变的影像学检查方法，以提高食管入口病变的影像学诊断水平。方法：回顾分析34例经临床、手术、穿刺和病理证实的食管入口病变患者的临床和影像学资料。34例均行CT检查，其中27例行增强前后CT扫描，7例仅行CT平扫。34例中有28例行X线钡剂检查。结果：34例食管入口病变包括原发于食管入口的肿瘤14例（鳞癌12例、未分化癌2例）、食管入口括约肌肥厚3例、食管入口憩室5例、食管入口损伤12例。34例食管入口病变均有吞咽障碍的临床症状，食管入口癌的中晚期，吞钡检查可见食管入口黏膜破坏。肿瘤早期CT表现不明显，中晚期病人食管入口壁可有不规则增厚或肿块。环咽肌肥厚者，CT表现为食管壁局部增厚，黏膜光滑。食管入口憩室者，CT表现为食管入口侧壁不强化的软组织肿块，吞钡可见食管一侧囊袋状龛影，有钡剂进入。食管入口破裂者吞钡时，可见钡剂溢入颈部软组织，2例食管入口破裂、穿孔并发纵膈脓肿者CT可见上纵膈增宽，增强扫描后见低密度脓腔。结论：X线钡剂检查对食管入口病变的诊断，目前仍有不可替代的作用，它简便易行、费用低廉、易被患者接受。CT对食管入口肿瘤的定性、分期，对食管入口损伤及其并发症的观察有重要意义，若将两者结合起来，能提高食管入口病变的影像学诊断水平。

The role of CT imaging and X-ray barium examination in the evaluation of esophageal inlet lesions

Objective：To analyze the radiological features of esophageal inlet lesions by CT and barium study in order to improve the diagnostic accuracy.Methods：The clinical and radiological data of 34 cases with esophageal inlet lesions were retrospectively analyzed.All cases were pathologically confirmed by surgery or biopsy.Twenty-seven patients underwent CT scan with contrast and 7 patients underwent plain CT scan.Twenty-eight patients underwent barium study.Results：Surgery or biopsy revealed 14 cases with primary esophageal tumor（12 cases of squamous carcinoma and 2 cases of undifferentiated can-cer）,3 cases were hypertrophy of sphincter,5 cases were diverticulum,12 cases were due to trauma.All patients presented with dysphagia.In cases with late stage esophageal cancer,barium study showed mucosa destruction.CT scan may have nega-tive findings in patients with early stage cancer while irregular thickening of esophagus or intra-luminal mass can be found in patients of late stage.In cases of hypertrophy of esophageal sphincter,CT scan showed localized wall thickening of esophagus with smooth mucosa.In cases of esophageal diverticulum,CT scan revealed unenhanced mass of esophageal inlet.Barium study showed niche filling with contrast.In patients with esophageal perforation,barium study showed contrast dissemination into cervical soft tissue.In 2 cases of esophageal perforation with superior mediastinal abscess,CT scan showed low density lesion with typical ring-like enhancement.Conclusion：Concerning low-cost,convenience and easy-to-perform,barium study remains irreplaceable in diagnosis of esophageal inlet lesions.CT is significant in staging of esophageal tumor and evaluation of esophageal trauma and its complications.Combining both methods can improve the diagnostic accuracy of esophageal inlet lesions.