CAJ | 학술논문

目的探讨超声内镜(EUS)和CT对判断食管癌能否根治性切除的临床价值.方法回顾性分析经手术治疗的746例食管癌患者的临床资料,按术前所行检查分为CT组(480例)、EUS组(151例)和EUS加CT组(115例),采用双盲法,对EUS和CT影像进行回顾性阅片,并将各组结果和手术病理结果进行对照研究.结果 CT组、EUS组和EUS加CT组患者的手术根治性切除率分别为91.0%、93.4%和93.9%;3组间差异无统计学意义(χ~2=1.551,P=0.484).CT组、EUS组和EUS加CT组术前判断手术根治切除率分别为81.7%、94.7%和96.5%(χ~2=15.131,P=0.000;χ~2=15.662,P=0.000;χ~2=0.502,P=0.346);诊断主动脉受侵率分别为91.3%、98.7%和9813%(χ~2=9.764,P=0.000;χ~2=6.659,P=0.004;χ~2=0.076,P=0.581);诊断气管支气管受侵率分别为91.3%、96.0%和98.3%(χ~2=3.729,P=0.034;χ~2=6.659,P=0.004;χ~2=1.117,P=0.248).结论 EUS诊断食管癌根治切除和主动脉受侵的临床价值高于CT;EUS和CT诊断气管支气管受侵的价值均较低;与单独应用EUS相比,CT和EUS的联合应用未能显著提高诊断食管癌的根治切除率.
목적 탐토초성내경(EUS)화CT대판단식관암능부근치성절제적림상개치.방법 회고성분석경수술치료적746례식관암환자적림상자료,안술전소행검사분위CT조(480례)、EUS조(151례)화EUS가CT조(115례),채용쌍맹법,대EUS화CT영상진행회고성열편,병장각조결과화수술병리결과진행대조연구.결과 CT조、EUS조화EUS가CT조환자적수술근치성절제솔분별위91.0%、93.4%화93.9%;3조간차이무통계학의의(χ~2=1.551,P=0.484).CT조、EUS조화EUS가CT조술전판단수술근치절제솔분별위81.7%、94.7%화96.5%(χ~2=15.131,P=0.000;χ~2=15.662,P=0.000;χ~2=0.502,P=0.346);진단주동맥수침솔분별위91.3%、98.7%화9813%(χ~2=9.764,P=0.000;χ~2=6.659,P=0.004;χ~2=0.076,P=0.581);진단기관지기관수침솔분별위91.3%、96.0%화98.3%(χ~2=3.729,P=0.034;χ~2=6.659,P=0.004;χ~2=1.117,P=0.248).결론 EUS진단식관암근치절제화주동맥수침적림상개치고우CT;EUS화CT진단기관지기관수침적개치균교저;여단독응용EUS상비,CT화EUS적연합응용미능현저제고진단식관암적근치절제솔.
Objective To evaluate the role of endoscopic ultrasonography (EUS) and CT in the prediction of the resectability of esophageal carcinoma. Methods A retrospective study was carried out in 746 patients with esophageal carcinoma. These patients were divided into CT group(480 cases), EUS group(151 cases) and EUS+CT group(115 cases). Images of EUS and CT were double-blindedly reviewed by radiologists. Relationship of EUS and CT images with surgical and pathological findings was examined. Results Resectation rates in the EUS group, CT group and EUS+CT group were 93.4%,91.0% and 93.9%, respectively (χ~2=1.551, P=0.484). Accuracy, sensitivity, specificity, positive predictive value and negative predictive value in the CT group were 81.7%, 87.4%, 23.3%, 92.0% and 15.4%, respectively; 94.7%, 98.6%, 40.0%, 95.9% and 66.7% in the EUS group; and 96.5%,99.1%, 57.1%, 97.3% and 80.0% in the EUS+CT group, respectively. When assessing aortic invasion,accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.3%,33.3%, 93.1%, 13.5% and 97.7%, in the CT group, respectively; 98.7%, 87.5%, 99.3%, 87.5% and 99.3% in the EUS group, respectively,and 98.3%, 85.7%, 99.1%, 85.7% and 99.1% in the EUS+CT group, respectively. In assessing tracheobronchial invasion, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.3%, 20.8%, 95.0%, 17.9% and 95.8% in the CT group, respectively; 96.0%, 20.0%, 98.6%, 33.3% and 97.3% in the EUS group, respectively;and 98.3%, 66.7%, 99.1%, 66.7% and 99.1% in the EUS+CT group. Differences in assessing resectability were significant between CT group and EUS group (χ~2=15.131, P=0.000), between CT group and EUS+CT group (χ~2=15.662, P=0.000), and between EUS group and EUS+CT group (χ~2=0.502, P=0.346). Differences in assessing aortic invasion were significant between CT group and EUS group (χ~2=9.764, P=0.000), and between CT group and EUS+CT group(χ~2=6.659, P=0.004), but were not significant between EUS group and EUS+CT group (χ~2=0.076, P=0.581 ). Differences in assessing tracheobronchial invasion were significant between CT group and EUS+CT group (χ~2=6.659, P=0.004), but were not significant between CT group and EUS group (χ~2=3.729, P=0.034) and between EUS group and EUS+CT group(χ~2=1.117, P=0.248). Conclusions EUS is a better procedure than CT in the prediction of the resectability and aortic invasion in esophageal carcinoma. There is limited value for EUS and CT in assessing traeheobronchial invasion. Combination of CT and EUS does not improve the prediction of reseetability significantly.