• 川北醫(yī)學院附屬醫(yī)院放射科(四川南充 637000);

目的  探討多層螺旋CT (MDCT)掃描對胃食管交界區(qū)癌(AEG)淋巴結(jié)轉(zhuǎn)移的診斷價值,并研究AEG淋巴結(jié)轉(zhuǎn)移的特點。
方法  回顧性分析2011年1月至2012年10月期間筆者所在醫(yī)院行手術(shù)治療并經(jīng)病理學檢查確診的60例AEG患者的MDCT影像資料,探討MDCT對AEG淋巴結(jié)轉(zhuǎn)移的診斷價值,并研究AEG的淋巴結(jié)轉(zhuǎn)移特點。
結(jié)果  以淋巴結(jié)短徑≥8mm、強化密度均值差≥70Hu作為判斷淋巴結(jié)轉(zhuǎn)移的標準時,其與術(shù)后病理學檢查結(jié)果的一致性較強(Kappa值分別為0.819和0.718),靈敏度(分別為83.1%和91.8%) 和特異度(分別為78.9%和83.5%)均較高。腫瘤侵犯漿膜面組的淋巴結(jié)轉(zhuǎn)移率高于漿膜面未受侵犯組(P<0.05)。轉(zhuǎn)移性淋巴結(jié)主要分布在食管下段胃賁門周圍(第7、8及9組)及胃小彎側(cè)、肝胃韌帶區(qū)和腹腔干區(qū)域(第10、11、12和14組),淋巴結(jié)轉(zhuǎn)移率分別為83.8%和82.3%。
結(jié)論  MDCT掃描有助于在術(shù)前準確發(fā)現(xiàn)AEG淋巴結(jié)的轉(zhuǎn)移部位、特點及規(guī)律,以便于術(shù)中準確地對轉(zhuǎn)移性淋巴結(jié)進行清掃。

引用本文: 王成龍,翟昭華,周海鷹,茍宗林,黃曉華,張亞雯. MDCT對胃食管交界區(qū)癌淋巴結(jié)轉(zhuǎn)移的診斷價值. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(6): 674-679. doi: 復(fù)制

1. Hasegawa S, Yoshikawa T. Adenocarcinoma of the esophagogastric junction:incidence, characteristics, and treatment strategies[J]. Gastric Cancer, 2010, 13(2):63-73.
2. 張祥宏, 王其彰. 對食管胃交界腺癌的認識和爭議[J]. 中華腫瘤雜志, 2008, 12(30):947-949.
3. Tsiouris A, Hammoud Z, Velanovich V. Barrett’s esophagus afterresection of the gastroesophageal junction:effects of concomitant fundoplication[J]. World J Surg, 2011, 35(8):1867-1872.
4. Inomata Y, Koike T, Ohara S, et al. Preservation of gastric acid secretion may be important for the development of gastroesophagealjunction adenocarcinoma in Japanese people, irrespective of the H. pylori infection status[J]. Am J Gastroenterol, 2006, 101(5):926-933.
5. Dent J. Pathogenesis and classification of cancer around the gastro-esophageal junction—not so different in Japan[J]. Am J Gastr-oenterol, 2006, 101(5):934-936.
6. 楊琳, 朱玥璐, 王斌, 等. 進展期食管胃交界腺癌臨床病理分析319例[J]. 世界華人消化雜志, 2012, 20(9):784-789.
7. 王龍, 劉巍, 呂雅蕾, 等. 食管胃結(jié)合部腺癌及胃癌Cox模型預(yù)后影響因素分析[J]. 中國腫瘤臨床, 2012, 39(19):1420-1425.
8. Griffiths EA, Pritchard SA, Mapstone NP, et al. Emerging aspectsof oesophageal and gastroesophageal junction cancer histopa-thology—an update for the surgical oncologist[J]. World J Surg Oncol, 2006, 4(4):82-98.
9. Koppert LB, Wijnhoven BP, Tilanus HW, et al. Neuroendocrine in barrett’s mucosa and adenocarcinomas of the gastroesophageal junction[J]. Int J Surg Pathol, 2004, 12(2):117-125.
10. Chandrasoma P, Wickramasinghe K, Ma Y, et al. Is intestinal metaplasia a necessary precursor lesion for adenocarcinomas ofthe distal esophagus, gastroesophageal junction and gastric cardia?[J]. Dis Esophagus, 2007, 20(1):36-41.
11. Chak A, Ochs-Balcom H, Falk G, et al. Familiality in barrett’s esophagus, adenocarcinoma of the esophagus, and adenocarcinoma of the gastroesophageal junction[J]. Cancer Epidemiol Biomarkers Prev, 2006, 15(9):1668-1673.
12. Gee DW, Rattner DW. Management of gastroesophageal tumors[J]. Oncologist, 2007, 12(2):175-185.
13. Lehrbach DM, Cecconello I, Ribeiro Jr U, et al. Adenocarcinoma of the esophagogastric junction:relationship between clinicopathological data and p53, cyclin D1 and Bcl-2 immunoexpressions[J]. Arq Gastroenterol, 2009, 46(4):315-320.
14. Gertler R, Stein HJ, Loos M, et al. How to classify adenocarcinomas of the esophagogastric junction:as esophageal or gastric cancer?[J]. Am J Surg Pathol, 2011, 35(10):1512-1522.
15. de Manzoni G, Zanoni A, Giacopuzzi S. Treatment of esophago-gastric junction adenocarcinoma[J]. Ann Ital Chir, 2012, 83(3):208-214.
16. 林家威, 黃順榮, 吳東波, 等. 64排螺旋CT三期增強掃描在胃癌淋巴結(jié)清掃術(shù)前評估中的價值[J]. 世界華人消化雜志, 2012, 20(7):596-600.
17. Mönig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer[J]. Ann Surg Oncol, 1999, 6(6):579-581.
18. Fukuya T, Honda H, Hayashi T, et al. Lymph-node metastases:efficacy for detection with helical CT in patients with gastric cancer[J]. Radiology, 1995, 197(3):705-711.
19. 姜波健, 吳巨鋼, 俞繼衛(wèi), 等. 胃癌淋巴管生成、淋巴管浸潤及淋巴結(jié)微轉(zhuǎn)移的臨床意義[J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(12):903-909.
20. 莫景雄, 黃力營. 胃癌淋巴結(jié)轉(zhuǎn)移CT分析[J]. 現(xiàn)代醫(yī)用影像學, 2012, 21(3):169-171.
21. 王成龍, 鄭興菊, 孫家瑜, 等. MDCT對胃食管交界區(qū)癌術(shù)前TN分期及分型的診斷價值[J]. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(4):446-451.
22. Paramo JC, Gomez G. Dynamic CT in the preoperative evaluation of patients with gastric cancer:correlation with surgical findings and pathology[J]. Ann Surg Oncol, 1999, 6(4):379-384.
23. Siewert JR, Stein HJ, Feith M. Adenocarcinoma of the esophago-gastric junction[J]. Scand J Surg, 2006, 95(4):260-269.
24. Shin SH, Jung H, Choi SH, et al. Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer[J]. Ann Surg Oncol, 2009, 16(5):1304-1309.
25. Mönig SP, Collet PH, Baldus SE, et al. Splenectomy in proximal gastric cancer:frequency of lymph node metastasis to the splenic hilus[J]. J Surg Oncol, 2001, 76(2):89-92.
  1. 1. Hasegawa S, Yoshikawa T. Adenocarcinoma of the esophagogastric junction:incidence, characteristics, and treatment strategies[J]. Gastric Cancer, 2010, 13(2):63-73.
  2. 2. 張祥宏, 王其彰. 對食管胃交界腺癌的認識和爭議[J]. 中華腫瘤雜志, 2008, 12(30):947-949.
  3. 3. Tsiouris A, Hammoud Z, Velanovich V. Barrett’s esophagus afterresection of the gastroesophageal junction:effects of concomitant fundoplication[J]. World J Surg, 2011, 35(8):1867-1872.
  4. 4. Inomata Y, Koike T, Ohara S, et al. Preservation of gastric acid secretion may be important for the development of gastroesophagealjunction adenocarcinoma in Japanese people, irrespective of the H. pylori infection status[J]. Am J Gastroenterol, 2006, 101(5):926-933.
  5. 5. Dent J. Pathogenesis and classification of cancer around the gastro-esophageal junction—not so different in Japan[J]. Am J Gastr-oenterol, 2006, 101(5):934-936.
  6. 6. 楊琳, 朱玥璐, 王斌, 等. 進展期食管胃交界腺癌臨床病理分析319例[J]. 世界華人消化雜志, 2012, 20(9):784-789.
  7. 7. 王龍, 劉巍, 呂雅蕾, 等. 食管胃結(jié)合部腺癌及胃癌Cox模型預(yù)后影響因素分析[J]. 中國腫瘤臨床, 2012, 39(19):1420-1425.
  8. 8. Griffiths EA, Pritchard SA, Mapstone NP, et al. Emerging aspectsof oesophageal and gastroesophageal junction cancer histopa-thology—an update for the surgical oncologist[J]. World J Surg Oncol, 2006, 4(4):82-98.
  9. 9. Koppert LB, Wijnhoven BP, Tilanus HW, et al. Neuroendocrine in barrett’s mucosa and adenocarcinomas of the gastroesophageal junction[J]. Int J Surg Pathol, 2004, 12(2):117-125.
  10. 10. Chandrasoma P, Wickramasinghe K, Ma Y, et al. Is intestinal metaplasia a necessary precursor lesion for adenocarcinomas ofthe distal esophagus, gastroesophageal junction and gastric cardia?[J]. Dis Esophagus, 2007, 20(1):36-41.
  11. 11. Chak A, Ochs-Balcom H, Falk G, et al. Familiality in barrett’s esophagus, adenocarcinoma of the esophagus, and adenocarcinoma of the gastroesophageal junction[J]. Cancer Epidemiol Biomarkers Prev, 2006, 15(9):1668-1673.
  12. 12. Gee DW, Rattner DW. Management of gastroesophageal tumors[J]. Oncologist, 2007, 12(2):175-185.
  13. 13. Lehrbach DM, Cecconello I, Ribeiro Jr U, et al. Adenocarcinoma of the esophagogastric junction:relationship between clinicopathological data and p53, cyclin D1 and Bcl-2 immunoexpressions[J]. Arq Gastroenterol, 2009, 46(4):315-320.
  14. 14. Gertler R, Stein HJ, Loos M, et al. How to classify adenocarcinomas of the esophagogastric junction:as esophageal or gastric cancer?[J]. Am J Surg Pathol, 2011, 35(10):1512-1522.
  15. 15. de Manzoni G, Zanoni A, Giacopuzzi S. Treatment of esophago-gastric junction adenocarcinoma[J]. Ann Ital Chir, 2012, 83(3):208-214.
  16. 16. 林家威, 黃順榮, 吳東波, 等. 64排螺旋CT三期增強掃描在胃癌淋巴結(jié)清掃術(shù)前評估中的價值[J]. 世界華人消化雜志, 2012, 20(7):596-600.
  17. 17. Mönig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer[J]. Ann Surg Oncol, 1999, 6(6):579-581.
  18. 18. Fukuya T, Honda H, Hayashi T, et al. Lymph-node metastases:efficacy for detection with helical CT in patients with gastric cancer[J]. Radiology, 1995, 197(3):705-711.
  19. 19. 姜波健, 吳巨鋼, 俞繼衛(wèi), 等. 胃癌淋巴管生成、淋巴管浸潤及淋巴結(jié)微轉(zhuǎn)移的臨床意義[J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(12):903-909.
  20. 20. 莫景雄, 黃力營. 胃癌淋巴結(jié)轉(zhuǎn)移CT分析[J]. 現(xiàn)代醫(yī)用影像學, 2012, 21(3):169-171.
  21. 21. 王成龍, 鄭興菊, 孫家瑜, 等. MDCT對胃食管交界區(qū)癌術(shù)前TN分期及分型的診斷價值[J]. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(4):446-451.
  22. 22. Paramo JC, Gomez G. Dynamic CT in the preoperative evaluation of patients with gastric cancer:correlation with surgical findings and pathology[J]. Ann Surg Oncol, 1999, 6(4):379-384.
  23. 23. Siewert JR, Stein HJ, Feith M. Adenocarcinoma of the esophago-gastric junction[J]. Scand J Surg, 2006, 95(4):260-269.
  24. 24. Shin SH, Jung H, Choi SH, et al. Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer[J]. Ann Surg Oncol, 2009, 16(5):1304-1309.
  25. 25. Mönig SP, Collet PH, Baldus SE, et al. Splenectomy in proximal gastric cancer:frequency of lymph node metastasis to the splenic hilus[J]. J Surg Oncol, 2001, 76(2):89-92.
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