食管癌术后吻合口的MDCT双期增强观察

发布时间：2018-03-13 10:25

  本文选题：食管癌　切入点：复发　出处：《河南科技大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1.应用MDCT增强扫描总结食管癌术后吻合口复发的增强CT表现;2.探讨食管癌术后吻合口复发的相关影响因素。方法:回顾性分析经胃镜病理证实的74例食管癌术后的增强MDCT扫描资料,依据CT征象及病理结果分为3组,正常吻合口组28例(n1),吻合口良性增厚组22例(n2),吻合口恶性增厚组24例(n3),对比分析三组病例吻合口相关征象。其中,男性50例,女性24例;年龄44~81岁,平均63.7±7.6岁,中位年龄64.39岁。距手术间隔时间1月~8年,平均28.39±27.22月,中位时间19.27月。检查采用Toshiba AquilionTM ONE 320排螺旋CT机,先行平扫120kV,200mAs,层厚5mm,层间距5mm,后经肘静脉团注对比剂(50~80ml,碘普罗胺(300mgI/ml)注射液),采用动态触发检查,兴趣区(refion of interest,ROI)选取气管分叉水平降主动脉,待ROI的CT值达200HU后延迟10s行动脉期扫描,40s后行静脉期扫描,所有的图像重建1mm薄层传递至工作站Vitrea FX Version6.3进行多平面重建(MPR),冠状位、矢状位重建厚度均为5mm。应用SPSS19.0统计学软件进行分析,P0.05表示差异有统计学意义,分析吻合口良性及恶性增厚与CT表现特征的相关性。采用单因素方差分析的统计学方法对n1、n2、n3三组吻合口区管壁厚度进行对比分析,Pearson相关分析、Spearman等级相关分析对CT特征进行相关性分析。利用卡方检验对年龄、性别、病理类型、原发肿瘤部位、分化程度、T分期、N分期及临床分期进行单因素分析,利用logistic进行多因素分析。结果:1.正常吻合口组、吻合口良性增厚组及吻合口恶性增厚组管壁厚度差异有统计学意义(P0.05),吻合口良性增厚组及吻合口恶性增厚组管壁厚度的最具意义临界值为17.2mm,此时敏感度为68.2%,特异度为93.3%。2.狭窄段粘膜中断与食管癌术后吻合口恶性增厚相关性较高,r=0.58(偏心型增厚、管腔肿块、不均匀强化、增厚的管壁上下缘不规则、狭窄段粘膜中断、动脉期强化幅度与吻合口恶性增厚均有一定相关性),而增厚管壁强化环及静脉期强化幅度对吻合口良、恶性增厚的鉴别无统计学意义。动脉期强化幅度的相关系数r=0.45,吻合口良性增厚组及吻合口恶性增厚组动脉期强化幅度的最具意义临界值为19.09Hu,此时的敏感度为72.7%,特异度为80.0%。3.N分期及临床Ⅲ期与食管癌术后吻合口复发有关,OR值分别为16.500、13.200。结论:1.增强MDCT对食管癌术后吻合口复发的诊断具有一定的影像特征性表现,对食管癌术后吻合口复发的诊断具有重要意义。2.N分期及临床Ⅲ期是食管癌术后吻合口复发的独立危险因素。
[Abstract]:Objective 1. To summarize the enhanced CT findings of anastomotic recurrence after esophageal cancer operation by using MDCT enhanced scanning. To investigate the related factors of anastomotic recurrence after esophageal cancer operation. Methods: 74 cases of esophageal carcinoma proved by gastroscopy were retrospectively analyzed. Contrast-enhanced MDCT scan data after operation, According to CT signs and pathological results, we divided into 3 groups: normal anastomosis group (n = 28), benign thickening group (n = 22) and malignant thickening group (n = 24). The median age was 64.39 years, with an average age of 63.7 卤7.6 years. The median time from January to 8 years was 28.39 卤27.22 months, and the median time was 19.27 months. Toshiba AquilionTM ONE 320 slice CT was used. First, 120kV of 200mAs, 5mm thick, 5mm interval, and then injected with 50 ~ 80ml of contrast agent and 300mgI / ml of iopramide through cubital vein mass. Dynamic trigger examination was used to select the descending aorta with trachea bifurcation level, and the area of interest was refion of interest. After the CT value of ROI reached 200HU, the arterial phase scan was delayed for 10 s and the venous phase scan was performed after 40 s. All the images were transferred to the workstation Vitrea FX Version6.3 for multiplanar reconstruction and coronal image reconstruction, and all the images were transferred to the workstation Vitrea FX Version6.3 for multiplanar reconstruction. The thickness of sagittal reconstruction was 5 mm. The difference was statistically significant by using SPSS19.0 statistical software to analyze the sagittal reconstruction thickness. To analyze the correlation between benign and malignant thickening of anastomotic stoma and CT features, a comparative analysis of the wall thickness of anastomotic area in n _ 1n _ 2n _ 3 group was carried out by single factor variance analysis and Spearman grade correlation analysis. Correlation analysis was carried out. Age was analyzed by chi-square test. Sex, pathological type, location of primary tumor, degree of differentiation, T stage and clinical stage were analyzed by univariate analysis and multivariate analysis by logistic. Results: 1. Normal anastomotic site group. There was significant difference in wall thickness between benign thickening group and malignant thickening group. The critical value of wall thickness in benign thickening group and malignant thickening group was 17.2 mm, and the sensitivity was 68.2 mm. The mucosal disruption of narrow segment was associated with malignant thickening of anastomotic stoma after esophagus cancer operation, and the correlation was higher (eccentricity thickening, eccentricity thickening). Lumen mass with uneven enhancement, irregular upper and lower margin of thickened wall, interrupted mucous membrane of narrow segment, enhancement amplitude of arterial phase and malignant thickening of anastomotic stoma were related to malignant thickening of anastomotic stoma. There was no statistical significance in the differentiation of malignant thickening. The correlation coefficient of enhancement amplitude in arterial phase was 0.45, the critical value of arterial enhancement in benign and malignant thickening group was 19.09 Hu. the sensitivity was 72.7%. The OR values related to anastomotic recurrence in stage 鈪，

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