食管术后胸内吻合口瘘的CT诊断准确性  

Accuracy of CT in Detecting Intrathoracic Anastomotic Leaks After Esophagectomy

作　　者：刘彩云 李绍东 徐凯 沙正布 苗新中 LIU Caiyun;LI Shaodong;XU Kai;et al(Xuzhou Cancer Hospital, Xuzhou, Jiangsu Province 221000, P. R. China)

机构地区：[1]徐州市肿瘤医院,221005 [2]徐州医科大学附属医院影像科 [3]徐州医科大学附属第三医院影像科,221000

出　　处：《临床放射学杂志》2018年第3期406-410,共5页Journal of Clinical Radiology

基　　金：徐州市2015年度科技计划项目(编号:KC15SH058);徐州市2015年度科技情报项目(编号:XKQ066)

摘　　要：目的探讨CT诊断食管术后胸内吻合口瘘（AL）的准确性。方法回顾性分析186例食管术后临床怀疑胸内AL患者资料,其中70例行口服对比剂（60%复方泛影葡胺）CT检查（口服对比剂组）,116例未口服对比剂CT检查（未口服对比剂组）。由两名影像科医师采用双盲法观察口服对比剂组、未口服对比剂组的CT图像。以胃镜检查或随访结果为金标准,应用受试者工作特征曲线（ROC）评价口服对比剂CT、未口服对比剂CT诊断效能。单变量分析筛选出CT征象中与AL相关的变量后,采用多变量Logistic回归分析,明确诊断AL的可靠征象。结果AL 49例,无AL 137例。口服对比剂CT诊断AL的敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）、准确度、ROC曲线下面积（AUC）分别为90.3%、97.4%、96.5%、92.7%、94.3%、0.939,未口服对比剂组以上诸值分别为72.2%、79.6%、39.4%、93.9%、78.4%、0.759,口服对比剂CT＋未口服对比剂CT（合计组）上述值分别为83.7%、84.7%、66.2%、93.5%、84.4%、0.842。口服对比剂明显提高PPV（从39.4%到96.5%,P﹤0.05）。多因素回归分析显示对比剂外溢有独立相关性。结论 CT可准确诊断食管术后胸内AL,口服对比剂可提高诊断准确率,对比剂外溢是最可靠征象。Objective To assess the diagnostic accuracy of CT in postoperative esophagus intrathoracic anastomotic leakage（ AL）. Methods The clinical data of 186 consecutive patients of suspected AL were retrospectively analyzed.Among these patients,70 were selected who had undergone postoperative CT with oral contrast,116 without oral contrast.Two independent blinded radiologists reviewed 186 CTs performed for suspected AL. Receiver operating characteristic（ ROC） were used to assess the diagnostic performances of CT with or without oral contrast. Associations linking each CT sign to a diagnosis of AL were evaluated using chi-square test. Using the statistically significant CT findings for AL,a multivariate logistic regression analysis was used to identify the most accurate diagnostic predictors. Results The diagnosis of AL was confirmed in 49 patients,the 137 patients without confirmed AL had good outcomes at followup period after initial surgery. The diagnostic sensitivity,specificity,and positive predictive values（ PPV）,negative predictive values（ NPV）,accuracy,and area under the alternative-free response ROC（ AUC） were 90. 3%,97. 4%,96. 5%,92. 7%,94. 3%,0. 939,using CT with oral contrast,72. 2%,79. 6%,39. 4%,93. 9%,78. 4%,0. 759,using CT without oral contrast,83. 7%,84. 7%,66. 2%,93. 5%,84. 4%,0. 842,using CT with and without oral contrast,respectively. Oral contrast increased PPV from 39. 4% to 96. 5%（ P 0. 05）. Contrast extravasation was the most accurate diagnostic predictors. Conclusion CT was accurate in diagnosing AL and performed better when combined with oral contrast,as contrast extravasation was the most reliable criterion.

关 键 词：吻合口瘘 体层摄影术 X线计算机 对比剂外溢 

分 类 号：R655.4[医药卫生—外科学] R816.4[医药卫生—临床医学]