经腹肠道超声在克罗恩病术后复发及合并症中的诊断价值
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摘要
目的评估经腹肠道超声在检测克罗恩病(CD)术后吻合口复发方面的准确性。方法选取2015年5月至2018年1月北京协和医院就诊的CD术后患者32例,行肠道超声检查,以肠镜和(或)手术病理和(或)临床评分为"金标准",将患者分为复发组与缓解组。采用χ2检验,评价超声征象在复发组与缓解组中的差异,采用四格表计算肠道超声诊断CD术后吻合口复发的敏感度、特异度、准确性阳性预测值和阴性预测值。结果复发组患者30例,缓解组患者2例。以吻合口处肠壁厚度> 0.3 cm及肠壁结构不清为诊断标准时,超声对CD复发的敏感度、特异度、阳性预测值和阴性预测值分别为97%、100%、100%、67%。确诊29例,超声诊断吻合口及其他部位肠瘘共15例(15/32)的准确性为100%,诊断吻合口狭窄共8例(8/32),准确性为100%。结论肠道超声在CD术后吻合口临床复发有特征性表现,在CD术后复发的监测和随访上有应用价值。
Objective To evaluate the accuracy of trans-abdominal ultrasound in detecting postoperative recurrence in crohn's disease. Methods A total of 32 patients in PUMCH who received curative resection for the treatment of CD were enrolled. All the patients underwent trans-abdominal ultrasound for the detection of postoperative recurrence of CD. Based on the enteroscopy, histopathology and the Crohn's Disease Active Index, we divided all patients into the active phase group and the quiescent phase group. To evaluate the diagnostic performance of transabdominal ultrasound in detecting postoperative recurrence of CD, the sensitivity, specificity, and positive and negative predictive value were measured. Results Among the 32 patients, there were 30 patients in the active phase group, and 2 in the quiescent group. For two ultrasonic signs, the bowel wall thickness > 3 mm, the loss of bowel wall stratification, the sensitivity, specificity, and positive and negative predictive value were 97%, 100%, 100%, 67%, respectively. A total of 29 cases were accurately diagnosed by ultrasound, and the overall accuracy of ultrasound in detecting fistula(on the anastomosis and other site) and anastomotic stenosis were 100%, 100%, respectively. Conclusions Due to the specific imaging features of clinical anastomotic recurrence, the trans-abdominal ultrasound plays an important role in monitoring the postoperative recurrence of CD.
Objective To evaluate the accuracy of trans-abdominal ultrasound in detecting postoperative recurrence in crohn's disease. Methods A total of 32 patients in PUMCH who received curative resection for the treatment of CD were enrolled. All the patients underwent trans-abdominal ultrasound for the detection of postoperative recurrence of CD. Based on the enteroscopy, histopathology and the Crohn's Disease Active Index, we divided all patients into the active phase group and the quiescent phase group. To evaluate the diagnostic performance of transabdominal ultrasound in detecting postoperative recurrence of CD, the sensitivity, specificity, and positive and negative predictive value were measured. Results Among the 32 patients, there were 30 patients in the active phase group, and 2 in the quiescent group. For two ultrasonic signs, the bowel wall thickness > 3 mm, the loss of bowel wall stratification, the sensitivity, specificity, and positive and negative predictive value were 97%, 100%, 100%, 67%, respectively. A total of 29 cases were accurately diagnosed by ultrasound, and the overall accuracy of ultrasound in detecting fistula(on the anastomosis and other site) and anastomotic stenosis were 100%, 100%, respectively. Conclusions Due to the specific imaging features of clinical anastomotic recurrence, the trans-abdominal ultrasound plays an important role in monitoring the postoperative recurrence of CD.
引文
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4王妙倩,李文波,朱庆莉,等.超声检查与计算机断层扫描肠道成像对克罗恩病诊断价值的对比[J].中华消化杂志,2018,38(2):121-125.
5郑凯,黄敏,郑家驹,等.经腹肠道超声对克罗恩病的诊断价值及其表现[J].中国医学影像技术,2011,27(1):112-115.
6 Sturm A,Maaser C,Calabrese E,et al.ECCO-ESGAR Guideline for Diagnostic Assessment in Inflammatory Bowel Disease[J].J Crohns Colitis,2019,13(3):273-284.
7 Limberg B.[Diagnosis of chronic inflammatory bowel disease by ultrasonography][J].Z Gastroenterol,1999,37(6):495-508.
8 Maconi G,Bollani S,Bianchi Porro G.Ultrasonographic detection of intestinal complications in Crohn's disease[J].Dig Dis Sci,1996,41(8):1643-1648.
9 Pallotta N,Civitelli F,Di Nardo G,et al.Small intestine contrast ultrasonography in pediatric Crohn's disease[J].J Pediatr,2013,163(3):778-784.
10 v De Cruz P,Kamm MA,Hamilton AL,et al.Crohn′s disease management after intestinal resection:a randomised trial[J].Lancet,2015,385(9976):1406-1417.
11 Kucharzik T,Wittig BM,Helwig U,et al.Use of Intestinal Ultrasound to Monitor Crohn′s Disease Activity[J].Clin Gastroenterol Hepatol,2017,15(4):535-542.
12 Maconi G,Nylund K,Ripolles T,et al.EFSUMB Recommendations and Clinical Guidelines for Intestinal Ultrasound(GIUS)in Inflammatory Bowel Diseases[J].Ultraschall Med,2018,39(3):304-317.
13 Maconi G,Sampietro GM,Cristaldi M,et al.Preoperative characteristics and postoperative behavior of bowel wall on risk of recurrence after conservative surgery in Crohn's disease:a prospective study[J].Ann Surg,2001,233(3):345-352.
14 Bernell O,Lapidus A,Hellers G.Risk factors for surgery and postoperative recurrence in Crohn′s disease[J].Ann Surg,2000,231(1):38-45.
15 Calabrese E,Maaser C,Zorzi F,et al.Bowel Ultrasonography in the Management of Crohn's Disease.A Review with Recommendations of an International Panel of Experts[J].Inflamm Bowel Dis,2016,22(5):1168-1183.
16 Rispo A,Bucci L,Pesce G,et al.Bowel sonography for the diagnosis and grading of postsurgical recurrence of Crohn′s disease[J].Inflamm Bowel Dis,2006,12(6):486-490.
17 Andreoli A,Cerro P,Falasco G,et al.Role of ultrasonography in the diagnosis of postsurgical recurrence of Crohn's disease[J].Am J Gastroenterol,1998,93(7):1117-1121.
2 Olaison G,Smedh K,Sj?dahl R.Natural course of Crohn′s disease after ileocolic resection:endoscopically visualised ileal ulcers preceding symptoms[J].Gut,1992,33(3):331-335.
3 Rutgeerts P,Geboes K,Vantrappen G,et al.Predictability of the postoperative course of Crohn′s disease[J].Gastroenterology,1990,99(4):956-963.
4王妙倩,李文波,朱庆莉,等.超声检查与计算机断层扫描肠道成像对克罗恩病诊断价值的对比[J].中华消化杂志,2018,38(2):121-125.
5郑凯,黄敏,郑家驹,等.经腹肠道超声对克罗恩病的诊断价值及其表现[J].中国医学影像技术,2011,27(1):112-115.
6 Sturm A,Maaser C,Calabrese E,et al.ECCO-ESGAR Guideline for Diagnostic Assessment in Inflammatory Bowel Disease[J].J Crohns Colitis,2019,13(3):273-284.
7 Limberg B.[Diagnosis of chronic inflammatory bowel disease by ultrasonography][J].Z Gastroenterol,1999,37(6):495-508.
8 Maconi G,Bollani S,Bianchi Porro G.Ultrasonographic detection of intestinal complications in Crohn's disease[J].Dig Dis Sci,1996,41(8):1643-1648.
9 Pallotta N,Civitelli F,Di Nardo G,et al.Small intestine contrast ultrasonography in pediatric Crohn's disease[J].J Pediatr,2013,163(3):778-784.
10 v De Cruz P,Kamm MA,Hamilton AL,et al.Crohn′s disease management after intestinal resection:a randomised trial[J].Lancet,2015,385(9976):1406-1417.
11 Kucharzik T,Wittig BM,Helwig U,et al.Use of Intestinal Ultrasound to Monitor Crohn′s Disease Activity[J].Clin Gastroenterol Hepatol,2017,15(4):535-542.
12 Maconi G,Nylund K,Ripolles T,et al.EFSUMB Recommendations and Clinical Guidelines for Intestinal Ultrasound(GIUS)in Inflammatory Bowel Diseases[J].Ultraschall Med,2018,39(3):304-317.
13 Maconi G,Sampietro GM,Cristaldi M,et al.Preoperative characteristics and postoperative behavior of bowel wall on risk of recurrence after conservative surgery in Crohn's disease:a prospective study[J].Ann Surg,2001,233(3):345-352.
14 Bernell O,Lapidus A,Hellers G.Risk factors for surgery and postoperative recurrence in Crohn′s disease[J].Ann Surg,2000,231(1):38-45.
15 Calabrese E,Maaser C,Zorzi F,et al.Bowel Ultrasonography in the Management of Crohn's Disease.A Review with Recommendations of an International Panel of Experts[J].Inflamm Bowel Dis,2016,22(5):1168-1183.
16 Rispo A,Bucci L,Pesce G,et al.Bowel sonography for the diagnosis and grading of postsurgical recurrence of Crohn′s disease[J].Inflamm Bowel Dis,2006,12(6):486-490.
17 Andreoli A,Cerro P,Falasco G,et al.Role of ultrasonography in the diagnosis of postsurgical recurrence of Crohn's disease[J].Am J Gastroenterol,1998,93(7):1117-1121.