• 四川大學華西醫(yī)院放射科(四川成都 610041);

目的  探討多層螺旋CT (MDCT)對胃食管交界區(qū)癌術(shù)前TN分期及分型的診斷價值。
方法  回顧性分析四川大學華西醫(yī)院2008年1月至2011年6月期間經(jīng)手術(shù)及病理檢查證實、術(shù)前完成MDCT掃描的149例胃食管交界區(qū)癌(adenocarcinoma of esophagogastric junction,AEG)患者的臨床資料,將術(shù)前MDCT檢查結(jié)果與術(shù)后結(jié)果對比分析。
結(jié)果  MDCT能準確對AEG進行術(shù)前TN分期及分型,對T1、T2、T3及T4期分期診斷的準確性分別為97.3%、91.3%、84.5%和89.3%; 對Ⅰ、Ⅱ、Ⅲ分型診斷的準確性分別為84.6%、63.8%和79.2%;對評價淋巴結(jié)是否轉(zhuǎn)移的準確性為88.6% (132/149),轉(zhuǎn)移淋巴結(jié)多以圓形和融合型、強化明顯和顯著以及環(huán)形強化和不均勻強化為特征,其病理轉(zhuǎn)移率較高(P=0.000)。
結(jié)論  術(shù)前MDCT檢查能準確判斷AEG的 TN分期、分型,有助于臨床制定手術(shù)方式、決定手術(shù)路徑。

引用本文: 王成龍,鄭興菊,孫家瑜,李真林,陳憲,伍兵. MDCT 對胃食管交界區(qū)癌術(shù)前TN 分期及分型的診斷價值. 中國普外基礎與臨床雜志, 2012, 19(4): 446-451. doi: 復制

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與爭議 [J]. 中華腫瘤雜志, 2008, 12(30):947-949..
3. Tsiouris A, Hammoud Z, Velanovich V. Barrett’s esophagus after resection of the gastroesophageal junction: effects of concomitant fundoplication [J]. World J Surg, 2011, 35(8):1867-1872.
4. 黃娟, 陳衛(wèi)霞, 王小鵬, 等. 多排螺旋CT 對胃癌T 分期的診斷價值 [J]. 四川大學學報( 醫(yī)學版), 2009, 40(6):1105-1109.
5. Rice TW, Blackstone EH, Rusch VW. A cancer staging primer:esophagus and esophagogastric junction [J]. J Thorac Cardiovasc Surg, 2010, 139(3):527-529.
6. Siewert JR, Stein HJ. Classification of adenocarcinoma of the esophagogastric junction [J]. Br J Surg, 1998, 85(11):1457-1459.
7. Meier I, Susanne M, Papadopoulos T, et al. Adenocarcinoma of the esophagogastric junction:the pattern of metastatic lymph node dissemination as a rationale for elective lymphatic target volume definition [J]. Int J Radiat Oncol Biol Phys, 2008, 70(5):1408-1417.
8. Lyratzopoulos G, Barbiere JM, Gajperia C, et al. Trends and variation in the management of oesophagogastric cancer patients:a population-based survey [J]. BMC Health Serv Res, 2009, 9:231.
9. 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.
10. Westerterp M, Koppert LB, Buskens CJ, et al. Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction [J]. Virchows Arch, 2005, 446(5):497-504.
11. 郭華, 楊志浩, 高劍波, 等. 進展期胃癌淋巴結(jié)轉(zhuǎn)移的螺旋CT 征象與病理學檢查相對照 [J]. 中國醫(yī)學影像技術(shù), 2009,25(7): 1211-1214..
12. Deans C, Yeo MS, Soe MY, et al. Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome [J]. World J Surg, 2011, 35(3):617-624.
13. Epari K, Cade R. Oesophagectomy for tumours and dysplasia of the oesophagus and gastro-oesophageal junction [J]. ANZ J Surg, 2009, 79(4):251-257.
14. Crumley AB, Stuart RC, Mckernan M, et al. Comparison of pre-treatment clinical prognostic factors in patients with gastrooesophageal cancer and proposal of a new staging system [J]. J Gastrointest Surg, 2010, 14(5):781-787.
15. 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.
16. Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer [J]. Ann Surg Oncol,2004, 11(7):682-689.
17. 彭俊生. 食管胃交界部腺癌術(shù)中脾門和脾動脈干淋巴結(jié)清掃與胰腺體尾脾臟能否保留 [J]. 中華胃腸外科雜志, 2010,13(9): 642-643..
18. 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.
19. Ott K, Bader FG, Lordick F, et al. Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction:a consecutive series of 240 patients at an experienced center [J].Ann Surg Oncol, 2009, 16(4):1017-1025.
20. Wayman J, Forman D, Griffin SM. Monitoring the changing pattern of esophago-gastric cancer:data from a UK regional cancer registry [J]. Cancer Causes Control, 2001, 12(10):943-949.
21. 劉巍, 宋麗楠, 關麗云, 等. 胸段食管癌及食管胃交界部癌根治術(shù)后患者生存質(zhì)量影響因素的研究 [J]. 中國腫瘤臨床,2009, 36(15): 875-878..
22. 催超, 孫立波, 舒振波, 等. 進展期近端胃癌根治術(shù)聯(lián)合脾臟切除術(shù)適應證的選擇 [J]. 中國普外基礎與臨床雜志, 2010,17(1):22-24..
23. Siewert JR, Stein HJ, Feith M. Adenocarcinoma of the esophago-gastric junction [J]. Scand J Surg, 2006, 95(4):260-269.
24. von Rahden BH, Stein HJ, Siewert JR. Surgical management of esophagogastric junction tumors [J]. World J Gastroenterol,2006, 12(41):6608-6613.
25. 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]. 中國普外基礎與臨床雜志,2008, 15(12):903-909..
  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與爭議 [J]. 中華腫瘤雜志, 2008, 12(30):947-949..
  3. 3. Tsiouris A, Hammoud Z, Velanovich V. Barrett’s esophagus after resection of the gastroesophageal junction: effects of concomitant fundoplication [J]. World J Surg, 2011, 35(8):1867-1872.
  4. 4. 黃娟, 陳衛(wèi)霞, 王小鵬, 等. 多排螺旋CT 對胃癌T 分期的診斷價值 [J]. 四川大學學報( 醫(yī)學版), 2009, 40(6):1105-1109.
  5. 5. Rice TW, Blackstone EH, Rusch VW. A cancer staging primer:esophagus and esophagogastric junction [J]. J Thorac Cardiovasc Surg, 2010, 139(3):527-529.
  6. 6. Siewert JR, Stein HJ. Classification of adenocarcinoma of the esophagogastric junction [J]. Br J Surg, 1998, 85(11):1457-1459.
  7. 7. Meier I, Susanne M, Papadopoulos T, et al. Adenocarcinoma of the esophagogastric junction:the pattern of metastatic lymph node dissemination as a rationale for elective lymphatic target volume definition [J]. Int J Radiat Oncol Biol Phys, 2008, 70(5):1408-1417.
  8. 8. Lyratzopoulos G, Barbiere JM, Gajperia C, et al. Trends and variation in the management of oesophagogastric cancer patients:a population-based survey [J]. BMC Health Serv Res, 2009, 9:231.
  9. 9. 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.
  10. 10. Westerterp M, Koppert LB, Buskens CJ, et al. Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction [J]. Virchows Arch, 2005, 446(5):497-504.
  11. 11. 郭華, 楊志浩, 高劍波, 等. 進展期胃癌淋巴結(jié)轉(zhuǎn)移的螺旋CT 征象與病理學檢查相對照 [J]. 中國醫(yī)學影像技術(shù), 2009,25(7): 1211-1214..
  12. 12. Deans C, Yeo MS, Soe MY, et al. Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome [J]. World J Surg, 2011, 35(3):617-624.
  13. 13. Epari K, Cade R. Oesophagectomy for tumours and dysplasia of the oesophagus and gastro-oesophageal junction [J]. ANZ J Surg, 2009, 79(4):251-257.
  14. 14. Crumley AB, Stuart RC, Mckernan M, et al. Comparison of pre-treatment clinical prognostic factors in patients with gastrooesophageal cancer and proposal of a new staging system [J]. J Gastrointest Surg, 2010, 14(5):781-787.
  15. 15. 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.
  16. 16. Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer [J]. Ann Surg Oncol,2004, 11(7):682-689.
  17. 17. 彭俊生. 食管胃交界部腺癌術(shù)中脾門和脾動脈干淋巴結(jié)清掃與胰腺體尾脾臟能否保留 [J]. 中華胃腸外科雜志, 2010,13(9): 642-643..
  18. 18. 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.
  19. 19. Ott K, Bader FG, Lordick F, et al. Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction:a consecutive series of 240 patients at an experienced center [J].Ann Surg Oncol, 2009, 16(4):1017-1025.
  20. 20. Wayman J, Forman D, Griffin SM. Monitoring the changing pattern of esophago-gastric cancer:data from a UK regional cancer registry [J]. Cancer Causes Control, 2001, 12(10):943-949.
  21. 21. 劉巍, 宋麗楠, 關麗云, 等. 胸段食管癌及食管胃交界部癌根治術(shù)后患者生存質(zhì)量影響因素的研究 [J]. 中國腫瘤臨床,2009, 36(15): 875-878..
  22. 22. 催超, 孫立波, 舒振波, 等. 進展期近端胃癌根治術(shù)聯(lián)合脾臟切除術(shù)適應證的選擇 [J]. 中國普外基礎與臨床雜志, 2010,17(1):22-24..
  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. von Rahden BH, Stein HJ, Siewert JR. Surgical management of esophagogastric junction tumors [J]. World J Gastroenterol,2006, 12(41):6608-6613.
  25. 25. 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]. 中國普外基礎與臨床雜志,2008, 15(12):903-909..