Duignan J P, McEntee G P, O'Connell D J, Bouchier-Hayes D J, O'Malley E
Mater Misericordiae Hospital, Dublin.
Ann R Coll Surg Engl. 1987 Nov;69(6):286-8.
The role of computed tomography in assessing tumour spread and tumour resectability was evaluated in 50 patients with oesophageal carcinoma (17 middle third, 33 lower third). CT accurately identified all patients with tumour confined to the oesophagus (Stage I or II) but was limited in its ability to assess direct organ invasion (Stage III) with an overall accuracy for evaluating middle third lesions of 82% (aorta 70%, tracheobronchial tree 94%, other mediastinal structures 82%) compared to an overall accuracy for lower third lesions of 97% (aorta 97%, pancreas 100%, diaphragm 97%). Tumours deemed resectable on CT were always resectable at operation but two of seven middle third tumours and one of twelve lower third lesions deemed unresectable underwent curative resection. Preoperative CT evaluation of oesophageal tumours is useful in that it may reliably identify tumour lesions confined to the oesophagus and reliably identify distant metastases. Because of its limitations however in the assessment of organ invasion, particularly by middle third lesions, this study suggests that patients with oesophageal tumours with no evidence of distant metastases, who are otherwise fit to undergo tumour resection, should not be denied surgery on the sole basis of positive organ invasion on CT particularly if that organ is the aorta.
对50例食管癌患者（17例食管中段癌，33例食管下段癌）进行了计算机断层扫描（CT）在评估肿瘤扩散及肿瘤可切除性方面作用的评估。CT能够准确识别所有肿瘤局限于食管的患者（Ⅰ期或Ⅱ期），但在评估直接器官侵犯（Ⅲ期）方面能力有限，评估食管中段病变的总体准确率为82%（主动脉70%，气管支气管树94%，其他纵隔结构82%），而评估食管下段病变的总体准确率为97%（主动脉97%，胰腺100%，膈肌97%）。CT判断为可切除的肿瘤在手术中均能成功切除，但7例食管中段肿瘤中有2例以及12例食管下段病变中有1例被CT判断为不可切除，但最终进行了根治性切除。术前CT评估食管肿瘤是有用的，因为它可以可靠地识别局限于食管的肿瘤病变以及远处转移。然而，由于其在评估器官侵犯方面存在局限性，尤其是食管中段病变，本研究表明，对于没有远处转移证据、其他方面适合进行肿瘤切除的食管肿瘤患者，不应仅基于CT显示器官侵犯阳性而拒绝手术，特别是当该器官为主动脉时。
