2种检查技术在小儿急性肠梗阻诊断中的价值对比  

Comparison of two examination methods in the diagnosis of acute intestinal obstruction in children

作　　者：高兵 张小晴 李春旺[1] 杨吉钱 李君伟[1] 蒋小俊 金科[1] GAO Bing;ZHANG Xiaoqing;LI Chunwang;YANG Jiqian;LI Junwei;JIANG Xiangjun;JIN Ke(Radiology Department,2.First Department of Neonates,Hunan Children′s Hospital,Changsha,Hunan,410007)

机构地区：[1]湖南省儿童医院放射科,湖南长沙410007 [2]湖南省儿童医院新生儿一科,湖南长沙410007

出　　处：《实用临床医药杂志》2020年第13期111-113,117,共4页Journal of Clinical Medicine in Practice

摘　　要：目的比较64层螺旋CT与数字化X线摄影(DR)技术在小儿急性肠梗阻诊断中的应用价值。方法选取本院疑似急性肠梗阻患儿81例为研究对象,均给予DR和CT检查。以手术或随访结果为“金标准”,分析2种检查方法诊断的准确率。结果81例患儿中,肠梗阻患儿58例,CT和DR诊断灵敏度分别为91.38%和87.93%,特异度分别为86.96和82.61%,准确率分别为90.12%和86.42%,一致性Kappa值分别为0.763和0.679,McNemar检验结果显示,2种检查方法差异无统计学意义(P>0.05);58例肠梗阻患儿中,粘连性梗阻19例,肠套叠16例,先天性肠梗阻11例,嵌顿疝5例,坏死性肠炎3例以及肠扭转4例,CT和DR对肠梗阻病因检查准确率分别为91.38%和75.86%,差异有统计学意义(P<0.05);58例肠梗阻患儿中,小肠低位梗阻48例(82.76%),小肠高位梗阻6例(10.34%),结肠梗阻4例(6.90%)。CT和DR对梗阻部位检查准确率分别为94.83%和82.76%,差异有统计学意义(P<0.05)。结论CT对小儿肠梗阻诊断准确率与DR检查相当,但对梗阻病因和部位判断较DR具有明显优势。Objective To compare the value of 64-slice spiral CT and digital radiography(DR)in the diagnosis of acute intestinal obstruction in children.Methods Eighty-one children with suspected acute intestinal obstruction were selected.All patients were given DR and CT examinations.The diagnostic accuracy rates of the two examination methods were analyzed by taking surgery or follow-up results as golden standards.Results Among the 81 children patients,there were 58 cases with intestinal obstruction,with a sensitivity of 91.38%in CT and 87.93%in DR,a specificity of 86.96%and 82.61%,respectively,the accuracy rate of 90.12%and 86.42%,respectively,and the consistency Kappa value of 0.763 and 0.679,respectively.McNemar test results showed no significant difference between the two groups(P>0.05).Among 58 children patients with intestinal obstruction,there were 19 cases with adhesive obstruction,16 cases with intussusception,11 cases with congenital intestinal obstruction,5 cases with incarcerated hernia,3 cases with necrotic enteritis and 4 cases with volvulus,and the accuracy rates of CT and DR for etiology of intestinal obstruction were 91.38%and 75.86%,respectively(P<0.05).Among 58 children patients with intestinal obstruction,there were 48 cases(82.76%)with low intestinal obstruction,6 cases(10.34%)with high intestinal obstruction and 4 cases(6.90%)with colon obstruction,with the accuracy rates of CT and DR for the obstruction site examination were 94.83%and 82.76%,respectively(P<0.05).Conclusion The accuracy rate of CT in diagnosis of intestinal obstruction is comparable to that of DR,but CT has obvious advantages over DR in the etiology and sites of obstruction.

关 键 词：急性肠梗阻 诊断 64层螺旋CT 数字化X线摄影 

分 类 号：R574.2[医药卫生—消化系统]