陈亮

[摘要] 目的 探讨多层螺旋CT对食管癌放疗后继发瘘的诊断价值，为临床提供科学依据。 方法 选择该院在2015年1月—2016年12月期间所收治的8例临床确诊为食管癌的患者作为研究对象，其中包括7例食管癌患者及1例食管癌术后复发患者，收集其临床资料，并回顾性分析患者经放射治疗后发生食管瘘的多层螺旋CT及食管造影资料。结果 应用多层螺旋CT对7例食管癌患者及1例食管癌术后复发患者均作出了食管癌继发瘘的诊断，其中，7例成功显示了食管瘘的瘘口；1例未显示瘘口，但有纵隔积气、积液等其他征象提示。2例食管造影未作出食管癌继发瘘的诊断，均由CT诊断后消化道内镜证实。 结论 食管癌放疗后继发瘘的临床表现通常较重，采取常规的食管造影方法在对细小瘘口的诊断上极易发生漏诊的现象，而通过多层螺旋CT扫描及其后处理（MPR）可以观察到其直接征象及间接征象，能够及时、准确地作出食管癌放疗后继发瘘的诊断，对临床治疗有非常重要的意义。

[关键词] 食管癌；食管瘘；体层摄影术；X线计算机

[中图分类号] R735 [文献标识码] A [文章编号] 1674-0742（2017）08（a）-0188-03

[Abstracts] Objective This paper tries to investigate the value of multi-slice spiral CT in the diagnosis of radiotherapy for esophageal carcinoma after radiotherapy， and to provide scientific basis for clinical treatment. Methods 8 cases of esophageal cancer patients in this hospital from January 2015 to December 2016 were selected， including 7 cases of esophageal cancer and 1 cases of postoperative recurrence of esophageal cancer， the clinical data were collected， and esophageal fistula spiral CT and esophageal imaging data were retrospectively analyzed. Results The multi-slice spiral CT was implemented in 7 cases of esophageal cancer and 1 cases of postoperative recurrence of esophageal cancer and diagnosis of the esophageal cancer were observed， 7 cases successfully showed esophageal fistula； 1 cases didnt show the fistula， but with pneumomediastinum， effusion and other signs. 2 cases of esophageal cancer didnt show secondary esophageal fistula diagnosis， all of which were confirmed by CT gastrointestinal endoscopy. Conclusion The clinical manifestations of esophageal cancer radiotherapy secondary fistula is usually severe， while the conventional method in the diagnosis of esophageal radiography of small fistula easily makes mistakes， and multi-slice spiral CT and postprocessing （MPR） can show the direct signs and other indirect symptoms， timely diagnose and make accurate radiotherapy of esophageal cancer secondary fistula， which is of great significance in clinical treatment.

[Key words] Esophageal carcinoma； Esophageal fistula； Tomography； X-ray computed

食管癌是常見的消化道恶性肿瘤，发病率男多于女，发病年龄多在40岁以上，早期症状不明显，大多数患者因进行性吞咽困难就诊，多已为中晚期，放射治疗是中晚期食管癌治疗的重要治疗方法之一，食管癌继发瘘是放射治疗后较严重的并发症，如不加以处理，有报道死亡率高达50%[1]，尽早发现并给予积极治疗可以明显改善患者的预后，该研究通过对该院2015年1月—2016年12月收治的8例经临床证实的食管癌放疗后继发瘘的病例，分析其多层螺旋CT表现，提高对该病的诊断水平，现报道如下。……