CT征象对成人回盲部肠套叠手术时机的预测价值
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摘要
目的:探讨预测成人回盲部肠套叠患者手术时机的特异性CT征象。方法:回顾性分析32例成人回盲部肠套叠患者的临床和CT影像资料,其中手术组22例,保守治疗组10例,由2名影像医师和2名临床医师对所有CT图像进行分析及术前评估。评价指标包括梗阻程度、肠套叠长度、"靶征"持续存在、套叠处肠壁水肿、腹腔积液共5种CT征象。统计比较手术组与保守治疗组患者CT征象的差异。结果:经Logistic回归模型分析,回盲部肠套叠的5种CT征象中,完全性肠梗阻、肠套叠长度(>5 cm)、"靶征"持续存在及套叠处肠壁水肿具有统计学意义(P<0.05);其中梗阻程度、肠套叠长度、"靶征"持续存在、套叠处肠壁水肿的OR>1。结论:梗阻程度、肠套叠长度、"靶征"持续存在及套叠处肠壁水肿4种CT征象对于预测成人回盲部肠套叠手术时机具有良好的参考价值。
Objective: To analyze the CT special features for predicting surgery timing of adult ileocecal intussusception. Methods: A retrospeive analysis was made on the clinical and imaging data of 32 cases of adult patients with ileocecal intussusception,including 22 patients of surgery group and 10 patients of conservative treatment group,and the all images were diagnosed and preoperative evaluated by two physicians and two clinical physicians. The evaluation index included 5 kinds of signs, including degree of obstruion, the length of intussusception, persistence of target sign, edema of intestinal wall and peritoneal fluid. The differences of signs were statistically compared between the surgery group and the conservative treatment group. Results: There were four of the five characteristic signs of predicting the need of surgery inpatients with ileocecal intussusception,of which were statistically significant by Logistic regression analysis,they were complete obstruion,the length of intussusception(>5 cm), persistence of target sign, edema of intestinal wall.The degree of obstruion, the length of intussusception, persistence of target sign, edema of intestinal wall,their OR> 1. Conclusion: The degree of obstruion、the length of intussusception, persistence of target sign and edema of intestinal wall has good reference value of predicting surgery timing of adult ileocecal intussusception.
Objective: To analyze the CT special features for predicting surgery timing of adult ileocecal intussusception. Methods: A retrospeive analysis was made on the clinical and imaging data of 32 cases of adult patients with ileocecal intussusception,including 22 patients of surgery group and 10 patients of conservative treatment group,and the all images were diagnosed and preoperative evaluated by two physicians and two clinical physicians. The evaluation index included 5 kinds of signs, including degree of obstruion, the length of intussusception, persistence of target sign, edema of intestinal wall and peritoneal fluid. The differences of signs were statistically compared between the surgery group and the conservative treatment group. Results: There were four of the five characteristic signs of predicting the need of surgery inpatients with ileocecal intussusception,of which were statistically significant by Logistic regression analysis,they were complete obstruion,the length of intussusception(>5 cm), persistence of target sign, edema of intestinal wall.The degree of obstruion, the length of intussusception, persistence of target sign, edema of intestinal wall,their OR> 1. Conclusion: The degree of obstruion、the length of intussusception, persistence of target sign and edema of intestinal wall has good reference value of predicting surgery timing of adult ileocecal intussusception.
引文
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[4]李志伟,刘云飞,张颖,等.CT征象预测粘连性小肠梗阻手术时机[J].中国医学影像技术,2016,12(3):394-396.
[5]Boke JWD,van der Burg LSB,Aarts NJM,et al.Intussusception in adults:rept of four cases and review of the literature[J].Gastroenterol,2007,1:59-64.
[6]黄越,徐学权,邱丽芹,等.成人肠套叠64-MS表现及致病点识别[J].中国医学计算机成像杂,2009,15:345-347.
[7]纪建松,章士正,邵初晓,等.螺旋对成人肠套叠的诊断及临床意义[J].中华医学杂志,2007,87:1129-1132.
[8]马万辉,王斌,张毅.成人肠套叠螺旋检查的临床意义[J].中国临床医学影像杂志,2005,16:688-669.
[9]Hayanga AJ,Bass-Wilkins K,Bulkley GB.Current management of small-bowel obstru CTion[J].Adv Surg,2005,39(1):1-33.
[10]肖宝来,胡小苗,沈霞蔚,等.成人肠套叠13例诊治分析[J].中国现代普通外科进展,2014,04:297-301.
[11]张锋刚,李传光,徐萌,等.小儿肠套叠的外科手术治疗[J].中国现代普通外科进展,2015,18(6):494-499.
[12]袁仁顺,胡浩,程化宾,等.成人肠套叠48例临床分析[J].江苏医药,2015,41(7):837-847.
[13]Goh BK,Quah HM,Chow PK,et al.Predi CTive fa CTors of malignancy in adults with intussusception[J].World J Surg,2006,30(7):1300-1304.
[14]彭方兴,贾乾斌,刘立新,等.成人肠套叠167例临床分析[J].中国普外基础与临床杂志,2005,12(1):37-38.
[15]杨维良,张伟峰,张东伟,等.成人肠套叠150例临床总结[J].中华普通外科杂志,2004,19(9):547-548.
[2]Hwang JY,Lee JK,Lee JE,et al.Value of multidete CTor CT indecision making regarding surgery in patients with small-bowelobstru C-Tion due to adhesion[J].Eur Radiol,2009,19(10):2425-2431.
[3]Millet I,Ruyer A,Alili C,et al.Adhesive small-bowel obstru CTion:Value of CT in identifying findings associated with the effe CTiveness of nonsurgical treatment[J].Radiology,2014,273(2):425-432.
[4]李志伟,刘云飞,张颖,等.CT征象预测粘连性小肠梗阻手术时机[J].中国医学影像技术,2016,12(3):394-396.
[5]Boke JWD,van der Burg LSB,Aarts NJM,et al.Intussusception in adults:rept of four cases and review of the literature[J].Gastroenterol,2007,1:59-64.
[6]黄越,徐学权,邱丽芹,等.成人肠套叠64-MS表现及致病点识别[J].中国医学计算机成像杂,2009,15:345-347.
[7]纪建松,章士正,邵初晓,等.螺旋对成人肠套叠的诊断及临床意义[J].中华医学杂志,2007,87:1129-1132.
[8]马万辉,王斌,张毅.成人肠套叠螺旋检查的临床意义[J].中国临床医学影像杂志,2005,16:688-669.
[9]Hayanga AJ,Bass-Wilkins K,Bulkley GB.Current management of small-bowel obstru CTion[J].Adv Surg,2005,39(1):1-33.
[10]肖宝来,胡小苗,沈霞蔚,等.成人肠套叠13例诊治分析[J].中国现代普通外科进展,2014,04:297-301.
[11]张锋刚,李传光,徐萌,等.小儿肠套叠的外科手术治疗[J].中国现代普通外科进展,2015,18(6):494-499.
[12]袁仁顺,胡浩,程化宾,等.成人肠套叠48例临床分析[J].江苏医药,2015,41(7):837-847.
[13]Goh BK,Quah HM,Chow PK,et al.Predi CTive fa CTors of malignancy in adults with intussusception[J].World J Surg,2006,30(7):1300-1304.
[14]彭方兴,贾乾斌,刘立新,等.成人肠套叠167例临床分析[J].中国普外基础与临床杂志,2005,12(1):37-38.
[15]杨维良,张伟峰,张东伟,等.成人肠套叠150例临床总结[J].中华普通外科杂志,2004,19(9):547-548.