内镜全层切除术后胸腹部CT表现分析  

Retrospective analysis of chest and abdominal CT presentations after endoscopic full-thickness resection

作　　者：范可扬 刘祖强 马丽云 陈巍峰 李全林 周平红 Fan Keyang;Liu Zuqiang;Ma Liyun;Chen Weifeng;Li Quanlin;Zhou Pinghong(Endoscopy Center,Zhongshan Hospital,Fudan University,Shanghai Collaborative Innovation Center of Endoscopy.Shanghai200032.China)

机构地区：[1]复旦大学附属中山医院内镜中心上海市内镜微创协同创新中心,上海200032

出　　处：《中华消化内镜杂志》2023年第7期550-555,共6页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金(82000507)。

摘　　要：目的总结内镜全层切除术(endoscopic full-thickness resection,EFR)后胸腹部CT表现,分析其对术后并发症评估与处理的提示意义。方法回顾性收集2016年9月-2021年9月在复旦大学附属中山医院内镜中心行消化道EFR治疗并在术后1周内行胸腹部CT检查的82例患者资料。根据术后有无特殊干预或住院天数延长分为术后干预组(38例)和对照组(44例),分析两组患者术后胸腹部CT异常表现发生率的差异,并分析CT异常表现的危险因素。结果82例患者中,胸腹部CT示气腹51例(62.2%),盆腹腔积液30例(36.6%),气胸5例(6.1%),胸腔积液43例(52.4%),肺部炎性改变16例(19.5%)。术后干预组CT表现盆腹腔积液(W=637.48,P=0.031)和胸腔积液(W=622.06,P=0.031)的发生率较对照组增高。患者年龄为EFR术后出现气体并发症的独立危险因素(>60岁比≤60岁:OR=0.17,95%CI:0.05~0.56.P=0.002)。结论EFR术后CT盆腹腔积液和胸腔积液对并发症的提示意义较大,而其他CT表现往往不需要特殊干预或延长住院时间,高龄患者术后复查CT发现气体并发症的可能性小。Objective To summarize the thoracic and abdominal CT presentations after endoscopic full-thickness resection(EFR)and to analyze its significance in the evaluation and management of postoperative complications.Methods Data of 82 patients who underwent gastrointestinal EFR at the Endoscopy Center of Zhongshan Hospital,Fudan University and received a chest and/or abdominal CT within 1 week from September 2016 to September 2021 were collected retrospectively.The patients were divided into the intervention group(n=38)and the control group(n=44)according to the presence or absence of special postoperative interventions or prolonged hospital stays.The differences in the incidence of abnormal CT presentations between the two groups were analyzed.Risk factors for abnormal CT presentation were explored by multifactorial analysis.Results Among the 82 patients,the main CT presentations were pneumoperitoneum in 51 patients(62.2%),abdominal and pelvic effusion in 30 patients(36.6%),pneumothorax in 5(6.1%),pleural effusion in 43(52.4%),and pulmonary inflammation in 16(19.5%).The incidence of pelvic and abdominal effusions(W=637.48,P=0.031)and pleural effusions(W=622.06,P=O.031)in CT was higher in the intervention group than that in the control group.Age was an independent risk factor for air-related complications after EFR(>60 years old VS≤60 years old:OR=0.17,95%CI:0.05-0.56,P=0.002).Conclusion CT presentations of pelvic and abdominal effusion and pleural effusion after EFR is of great significance in suggesting complications,while patients with other CT presentations often do not require special intervention or prolonged hospital stay.Postoperative CT in elderly patients is less likely to detect air-related complications.

关 键 词：手术后并发症 黏膜下肿瘤 内镜全层切除术 计算机断层扫描 

分 类 号：R656[医药卫生—外科学]