CT对急性闭合性肠及肠系膜损伤手术治疗的预测价值  

Predictive value of CT in surgical treatment of acute closed intestinal and mesenteric injuries

作　　者：符熙 彭加友[1] 何伟红[1] 杨延斌[2] 黄华仪 FU Xi;PENG Jiayou;HE Weihong;YANG Yanbin;HUANG Huayi(Department of Radiology,Foshan ChineseMedicine Hospital Affiliated to Guangzhou University of Chinese Medicine,Foshan 528000,China;Medical Record Room,Foshan Chinese Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine,Foshan 528000,China)

机构地区：[1]广州中医药大学附属佛山市中医院放射科,广东佛山528000 [2]广州中医药大学附属佛山市中医院病案统计室,广东佛山528000

出　　处：《实用放射学杂志》2019年第10期1614-1617,1680,共5页Journal of Practical Radiology

基　　金：佛山市医学类科技攻关项目(2017AB002821)。

摘　　要：目的探讨CT不同征象对急性闭合性肠及肠系膜损伤手术治疗预测评估的准确性。方法回顾性分析120例入院即进行腹部CT扫描的急性闭合性肠及肠系膜损伤患者的CT影像资料及随访结果,其中需手术治疗58例,保守治疗62例,分析不同CT征象对肠及肠系膜损伤诊断及手术预测价值。结果手术组和保守治疗组肠系膜血管截断、肠系膜血肿、血管对比剂外渗、肠壁缺损、腹腔积气及腹腔积液差异有统计学意义(χ2=4.69,P=0.03;χ2=21.40,P<0.001;χ2=13.95,P<0.001;χ2=11.34,P=0.001;χ2=80.65,P<0.001)。腹腔积液对肠及肠系膜损伤手术预测敏感性最高,血管对比剂外渗及肠壁缺损对肠及肠系膜损伤手术预测特异性最高。ROC曲线分析显示腹腔积气对肠及肠系膜损伤手术预测价值最高,AUC=0.92(95%CI:0.87~0.97),其次是肠系膜血肿,AUC=0.73(95%CI:0.64~0.82)。结论腹腔积液对肠及肠系膜损伤手术预测敏感性最高,血管对比剂外渗及肠壁缺损对肠及肠系膜损伤手术预测特异性最高。腹腔积气对肠及肠系膜损伤手术预测价值最高。结合不同的CT征象可以提高临床干预急性闭合性肠及肠系膜损伤的准确性。Objective To explore the predictive value of different CT signs in surgical treatment in patients with acute closed intestinal and mesenteric injury.Methods The CT data and follow-up results of 120 patients with acute closed intestinal and mesenteric injury, including 58 cases of surgical treatment and 62 cases of conservative treatment) were analyzed retrospectively.The diagnostic value and prognostic value in surgical treatment of different CT signs were analyzed. Results There were significant differences between the operation group and the conservative treatment group in mesenteric vascular amputation,mesenteric hematoma, vascular contrast agent extravasation, intestinal wall defect,pneumoperitoneum and peritoneal effusion (χ2=4.69, P=0.03;χ2=21.40,P<0.001;χ2 = 13.95,P<0.001;χ2=11.34,P=0.001;χ2=80.65,P<0.001).The CT signs of intrapcritoncal effusion had the highest sensitivity for intestinal and mesenteric injury,and vascular contrast agent extravasation and intestinal wall defect had the highest specificity for surgical predictability of intestinal and mesenteric injury.ROC curves showed that abdominal gas accumulation had the highest predictive value for intestinal and mesenteric injuries (AUC=0.92 (95% CI: 0.87-0.97), followed by mesenteric hematoma (AUC=0.73,95%C1:0.64-0.82). Conclusion Intraperitoneal effusion has the highest sensitivity for intestinal and mesenteric injury,and vascular contrast agent extravasation and intestinal wall defect have the highest specificity for surgical predictability of intestinal and mesenteric injury.The overall value of intraperitoneal gas in predicting intestinal and mesenteric injury is highest.Combining different CT signs can improve the accuracy of clinical intervention for acute closed intestinal and mesenteric injury.

关 键 词：肠 肠系膜损伤 计算机体层成像 

分 类 号：R657.2[医药卫生—外科学] R814.42[医药卫生—临床医学]