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目的探讨胸段食管癌行彩超和磁共振(MR)检查对于指导选择颈部淋巴结清扫的临床应用价值。方法选取2010年~2013年我院胸段食管癌患者53例,术前常规行颈部淋巴结彩超以及颈部MR检查,所有患者均行三野淋巴结清扫。结果 53例患者中经病理证实颈部淋巴结转移12例(22.6%),其中22例胸上段食管癌颈部淋巴结转移有10例(45.5%),31例胸中、下段食管癌颈部淋巴结转移有2例(6.5%)。13例经病理证实颈部淋巴结转移患者中术前行颈部彩超和MR检查提示颈部淋巴结转移阳性者11例(准确性达84.6%)。结论胸段食管癌术前行彩超和MR检查对选择是否行颈部淋巴结清扫具有重要价值,特别是对于中、下段食管癌,颈部淋巴结转移较少者。若彩超以及MR未提示颈部淋巴结肿大,行二野清扫术完全可以达到根治目的,不必行三野清扫,从而减少不必要的手术创伤,降低手术风险,提高手术治疗效果。
Objective To investigate the clinical value of color Doppler ultrasound and magnetic resonance (MR) examination of thoracic esophageal carcinoma in guiding the choice of cervical lymph node dissection. Methods From 2010 to 2013, 53 patients with thoracic esophageal cancer in our hospital were selected. Preoperative cervical lymph node ultrasonography and neck MR examination were performed. All patients underwent three-node lymph node dissection. Results Of the 53 patients, 12 cases (22.6%) had cervical lymph node metastasis confirmed by pathology. Among them, 10 cases (45.5%) had cervical lymph node metastasis in 22 cases of upper thoracic esophagus and 31 cases had cervical lymph node metastasis in lower thoracic esophagus 2 cases (6.5%). Thirteen patients with pathologically confirmed cervical lymph node metastasis underwent preoperative cervical ultrasonography and MR examination in 11 cases with positive cervical lymph node metastasis (accuracy of 84.6%). Conclusion Preoperative ultrasound and MR examination of thoracic esophageal cancer is of great value in choosing whether to perform cervical lymph node dissection. Especially for the middle and lower esophageal cancer, cervical lymph node metastasis less. If ultrasound and MR did not prompt the neck lymph nodes, line two wild scans can achieve the radical goal, do not line San field clearance, thereby reducing unnecessary surgical trauma, reduce surgical risk and improve surgical treatment.