CT与楔入法门静脉造影术在儿童Rex术前诊断价值的比较  

Comparison of the preoperative diagnostic value of CT and WHVP in pediatric Rex surgery

作　　者：吴慧莹 周宁 鹿连伟 刘珍银 陈希文 刘涛 刘玉涛 WU Huiying;ZHOU Ning;LU Lianwei;LIU Zhenyin;CHEN Xiwen;LIU Tao;LIU Yutao(Department of Radiology,Guangzhou Women's and Children's Medical Center,Guangzhou 510623,China;Department of Interventional and Vascular Anomalies,Guangzhou Women's and Children's Medical Center,Guangzhou 510623,China;Department of Pediatric Surgery,Guangzhou Women's and Children's Medical Center,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心放射科,广东广州510623 [2]广州市妇女儿童医疗中心介入和血管瘤科,广东广州510623 [3]广州市妇女儿童医疗中心小儿外科,广东广州510623

出　　处：《实用放射学杂志》2022年第4期629-633,共5页Journal of Practical Radiology

基　　金：广东省科技厅科技计划项目(2016A020215021);广东省医学科研基金项目(A2021261).

摘　　要：目的分析比较CT与楔入法门静脉造影术(WHVP)在肝外门静脉梗阻(EHPVO)儿童肠系膜上静脉G门静脉左支分流术(Rex术)术前诊断的价值以及两者的关系,优化EHPVO儿童的检查流程.方法回顾性分析76例经手术证实的EHPVO儿童的临床、WHVP及CT资料,其中68例行Rex术,8例行远端脾肾分流术(DSRS/Warren术).结果34例行术前WHVP,其中3例造影失败,31例成功(27例A级,2例B级,2例E级).WHVP术前诊断Rex窝通畅性的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率均为100%.76例行腹部CT增强检查,55例的Rex窝直径0.6~10.5mm,平均(3.5±1.8)mm,2例仅显示Rex肝Ⅲ段分支,19例无法辨认Rex窝以及其分支.以可辨认Rex及其分支判断为Rex窝通畅,无法显示Rex及其分支则需要进一步评估病例为标准,CT诊断Rex窝通畅性的敏感性、特异性、阳性预测值、阴性预测值和诊断符合率分别为100%、83.8%、42.1%、100%和85.5%.WHVP及术前CT在术前判断Rex窝通畅性方面,两者诊断效能相似(McNemar检验,P=0.50),具有中度一致性(Kappa=0.635,P=0.000),且WHVP优于CT(WHVP的约登指数=1.0,CT的约登指数=0.84).结论在术前判断Rex窝通畅性方面,CT与WHVP诊断效能相当,具有中度一致性.当术前CT无法确认Rex窝通畅性时,需行WHVP检查.Objective To analyze and compare the diagnostic value of preoperative CT and wedged hepatic vein(retrograde)portography(WHVP)to optimize the examination process in pediatric extrahepatic portal vein obstruction(EHPVO)before Rex surgery.Methods The clinical data,WHVP and CT characteristics of 76 children with EHPVO,who underwent Rex surgery(n=68)or distal splenorenal shunt/Warren surgery(DSRS/Warren)(n=8),were retrospectively analyzed.Results 34 cases underwent preoperative WHVP.3 cases failed and 31 succeed,with 27 cases of grade A,2 cases of grade B,and 2 cases of grade E.The sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy rate of WHVP preoperative diagnosis of Rex recess patency were all 100%.76 cases underwent abdomen CT enhanced examination,55 cases Rex recess diameter was 0.6-10.5 mm,and the mean diameter was(3.5±1.8)mm.2 cases only showed segment IB,and 19 cases could not identify the Rex recess and its branches.Rex surgery could be performed in patients who could identify the Rex recess and its branch,and those who could not identify required further evaluation.The sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy rate of CT were 100%,83.8%,42.1%,100%,and 85.5%,respectively.The preoperative diagnostic efficiency of WHVP and CT was equivalent(McNemar test,P=0.50),with moderate consistency(Kappa=0.635,P=0.000),and WHVP was superior to CT(WHVP's Youden index=1.0,CT's Youden index=0.84).Conclusion The preoperative diagnostic efficiency of CT and WHVP is equivalent,with moderate consistency.If CT could not confirm the diagnosis.further inspection by WHVP is required.

关 键 词：肝外门静脉梗阻 门静脉造影术 计算机体层成像 儿童 

分 类 号：R543.6[医药卫生—心血管疾病] R814.43[医药卫生—内科学] R814.42[医药卫生—临床医学]