超声内镜在食管癌多学科综合治疗中的临床应用价值分析

Clinical value of endoscopic ultrasonography in multidisciplinary therapy for esophageal carcinoma

摘要:

目的 比较单独CT、CT联合超声内镜（EUS）在食管癌术前T、N分期的准确性，并评估EUS对治疗方案的影响。方法 选取2015年1月—2018年5月安阳肿瘤医院收治的食管癌患者750例，随机抽签分为单独CT组388例和CT联合EUS（CT-EUS）组362例。参照AJCC第8版TNM分期标准进行分期，并将单独CT组、CT-EUS组的临床分期结果与术后病理分期结果进行对比分析，比较两组患者内镜下黏膜切除术（EMR）、新辅助治疗、镜下完全切除（R0）率、中转开胸率及术中并发症情况。结果 单独CT组、CT-EUS组对T期的诊断准确率分别为67.0%和83.5%，对N分期的诊断准确率分别为75.1%和85.6%，差异有统计学意义（P?<0.05）。Kappa一致性检验分析提示CT-EUS组T、N分期一致性优于单独CT组。CT-EUS组与单独CT组比较，中转开胸率、术中出血及气管损伤率低（P?<0.05），R0切除率高（P?<0.05）；CT-EUS组较单独CT组EMR使用率低，新辅助治疗率高，但差异无统计学意义（P?>0.05）。结论 CT-EUS较单独CT可提高食管癌术前T、N分期准确性，但对食管癌综合治疗方案影响有限。

Abstract:

Objective To compare the accuracy of computed tomography (CT) alone and CT combined with EUS (CT-EUS) in deciding preoperative T and N staging of esophageal carcinoma (EC), respectively, and to assess the impact of EUS after CT on the treatment of EC patients. Methods A total of 750 patients with esophageal cancer were selected from Jan 2015 to May 2018 in our hospital, and all patients were randomized into the CT group (388 cases) and the CT-EUS group (362 cases). According to the TNM staging system (AJCC Eighth Edition), and stages were compared with surgical pathology, which as the gold standard. The rate of EMR, R0, perioperative complication, conversation and neoadjuvant therapy were compared respectively. Results The T and N staging accuracy rate of CT examinations were 67.0%, 75.1%, and 83.5%, 85.6% were in two groups respectively with significant difference (P??0.05). Conclusions The accuracy of EUS combined with CT is superior to CT-alone in preoperative T, N staging of esophageal caicinoma, but had limited impact on the multidisciplinary treatment decisions.