食管癌术前分期评价——食管腔内超声、计算机断层扫描和传统临床分期比较

目的比较食管腔内超声（ＥＵ）、计算机断层扫描（ＣＴ）和传统临床分期对食管癌术前分期的价值。方法３６例食管癌患者,术前均进行ＥＵ检查,其中８例（２２２％）因管腔严重狭窄未获全面评估。２１例进行了ＣＴ分期。ＥＵ、ＣＴ和传统临床分期结果分别与手术病理分期比较。结果传统临床分期准确率仅为３６％,ＣＴ对肿瘤浸润程度、局部淋巴结受累及ＰＴＮＭ分期的准确率分别为３８１％、５７１％和４７６％,ＥＵ为７７８％、７２２％和７０２％,去除严重狭窄病例后进一步提高至８５７％、７８６％和８３１％。结论食管癌传统分期方法准确性欠佳。ＣＴ能明确显著的肿瘤外浸,并且是除外远处转移的最佳手段,但无法精确区分早、中期肿瘤,因而对手术帮助有限。ＥＵ对于食管癌术前区域分期具有较高的准确性,因此对治疗方法的选择和疗效的改进具有重要价值

Preoperative staging of esophageal carcinoma: comparison of endoesophageal ultrasonography, computerized tomography and conventional clinical staging

Objective To evaluate the value of different methods in preoperative staging of esophageal carcinoma. Method Thirty six patients undergoing resection of esophageal carcinoma were examined with endoesophageal ultrasonography (EU) before operation. Eight of 36 patients could not be evaluated because of severe esophageal stenosis. Computerized tomography(CT) was performed in 21 patients. Comparison was made between stagings based on EU, CT as well as the conventional clinical staging system, respectively with surgical pathological staging after resection. Result The accuracy of conventional clinical staging for esophageal cancer was only 36%. The accuracy of CT in T,N and pTNM staging was 38 1%, 57 1% and 47 6% respectively. For EU, the figures were 77 8%, 72 2% and 72 2%, and were improved to be 85 7%, 78 6% and 83 1% when untraversable patients were excluded. Conclusion While conventional clinical staging system lacks accuracy in evaluating esophageal carcinoma, CT makes only moderate improvement. Based on direct morphological examination of lesions, EU is highly accurate in preoperative staging of esophageal carcinoma, especially in evaluating the extent of luminal wall invasion and regional lymph node involvement. Therefore, EU is of critical value in the therapeutic selection for esophageal carcinoma.