胸部CT对肺癌纵隔侵犯及手术切除可能性的评价

Computerized tomography for evaluation of resectability of lung cancer with indeterminate mediastinal invasion

  • 摘要: 本文收集了我院近年来100例胸部CT检查上显示肿瘤与纵隔相接触,但又不能确定是否有直接侵犯的肺癌病例,结合手术情况分析了CT表现与手术切除可能性之间的关系。作者认为,肿瘤与纵隔的接触直径及纵隔脂肪垫的存在与否,对于术前判断肿瘤能否切除有一定参考价值。CT上显示肿瘤与纵隔相接触的病例中,约有半数肿瘤并未直接侵犯纵隔。

     

    Abstract: The CT scans of 100 patients with lung cancer, interpreted as indeterminate mediastinal invasion, were retrospectively reviewed following thoracotomy. Forty-eight (48%) cases with lung masses were resectable without invasion of the mediastinum. Thirty-two (32%) focally invaded the mediastinum but were technically resectable, and the remaining 20 were unresectable because of severe mediastinal invasion. The CT features that were analyzed included the diameter of contact with the mediastinum, the fat plate, and the angles formed with the descending aorta and the mediastinum. We found that if the diameter of contact with the mediastinum was less than 3 cm or the fat plate between the tumor and the mediastinum did not disappear, it was almost certain that the tumor could be resected (>95%). The angles formed with the descending aorta and the mediastinum were insignificant for evaluation of resectability. Our results indicate that although CT is generally not helpful in differentiating lung masses with or without mediastinal invasion, it may play an important role in separating a large number of masses that are highly likely to be technically resectable.

     

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