MSCT在新生儿Ⅲ型食管闭锁术前评估中的应用研究  

Application of MSCT in the Preoperative Evaluation of Neonatal TypeⅢEsophageal Atresia

作　　者：戴李华 马慧[1] 曾甜[2] 李新宁[2] 苏永焕 王万芝 DAI Lihua;MA Hui;ZENG Tian;LI Xinning;SU Yonghuan;WANG Wanzhi(Department of Radiology,The Maternal&Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning Guangxi 530021,China;Neonatal Surgical,The Maternal&Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning Guangxi 530021,China)

机构地区：[1]广西壮族自治区妇幼保健院放射科,广西南宁530021 [2]广西壮族自治区妇幼保健院新生儿外科,广西南宁530021

出　　处：《中国医疗设备》2022年第3期134-137,共4页China Medical Devices

基　　金：广西壮族自治区卫生健康委员会科研课题(Z20200755,Z20190899)。

摘　　要：目的研究多层螺旋CT(Multi-Slice CT,MSCT)及3D后处理重建技术在新生儿Ⅲ型食管闭锁术前评估中的应用。方法回顾性分析32例先天性Ⅲ型食管闭锁患儿的MSCT资料,所有患儿均行食管造影明确诊断后采用MSCT检查,检查前充分准备,检查后图像给予3D后处理重建,与手术结果进行对照研究。结果32例患儿MSCT检查图像均能清楚显示近端食管闭锁的位置,其中30例显示远端食管气管瘘口位置,瘘口开口位于气管下段的25例、隆突处的4例、左主支气管的1例,准确测量出食管两盲端距离,按照Gross分型,诊断Ⅲa型5例、Ⅲb型25例,其与手术所见远端食管瘘口位置、食管两盲端距离、分型相符;其中2例远端瘘口位置显示不清。同时显示肺部炎症29例,气管发育异常8例,胸椎畸形1例,先天性心脏病2例。MSCT与手术结果比较,显示瘘口的一致性Kappa值为0.819;分型的Kappa值为0.824,两者结果的一致性均很好。结论MSCT可以准确对新生儿Ⅲ型食管闭锁进行诊断,通过扫描前充分准备及CT检查图像3D后处理重建,可充分显示远端食管瘘口并准确测量出食管两盲端距离,进行精准分型,为临床制定手术方案提供可靠的影像学依据。Objective To study the use of the multi-slice CT(MSCT)and 3D post-processing reconstruction techniques in the preoperative assessment of neonatal typeⅢesophageal atresia.Methods MSCT data of 32 children with congenital typeⅢesophageal atresia were retrospectively analyzed.All children underwent esophagography to clarify the diagnosis and then MSCT was used,with adequate preparation before the examination,and the images were given 3D post-processing reconstruction after the examination for a controlled study with the surgical findings.Results 32 cases underwent MSCT examination clearly showed the location of the proximal esophageal atresia,30 cases showed that the distal esophageal tracheal fistula location.Of them,the fistula openings were located in the lower trachea in 25 cases,in the carina in 4 cases,and in the left main bronchus in 1 case.The distance between the two blind ends of the esophagus was accurately measured,according to Gross classification,5 cases were diagnosed typeⅢa and 25 were typeⅢb.The results were consistent with what seen in the surgery operation.2 cases left could not clearly show the location of the distal fistula.At the same time,29 patients had pulmonary inflammation,8 had abnormal tracheal development,1 had thoracic deformity and 2 had congenital heart disease.Comparing the results of MSCT and surgery,the consistency of Kappa value in showing fistula was 0.819;the Kappa value in showing classification was 0.824.The consistency of the two results was very good.Conclusion MSCT can accurately diagnose typeⅢesophageal atresia in neonates.Through adequate preparation before scanning and 3D post-processing and reconstruction of CT images,it can fully display the location of the distal esophageal fistula,accurately measure the distance between the two blind ends of the esophagus,and accurately classify.It can provide a reliable imaging basis for clinical formulation of surgical plans.

关 键 词：多层螺旋CT 食管闭锁 气管食管瘘 Gross分型 术前评估 

分 类 号：R726.2[医药卫生—儿科] R814.42[医药卫生—临床医学]