中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2012年
1期
28-30
,共3页
李涛%周建峰%王浩%陆如刚%黄磊%赵萌%唐文伟%张晓军
李濤%週建峰%王浩%陸如剛%黃磊%趙萌%唐文偉%張曉軍
리도%주건봉%왕호%륙여강%황뢰%조맹%당문위%장효군
体层摄影术,X线计算机%肠扭转%肠梗阻
體層攝影術,X線計算機%腸扭轉%腸梗阻
체층섭영술,X선계산궤%장뉴전%장경조
Tomography,X-ray computed%Intestinal volvulus%Intestinal obstruction
目的 评估CT检查单一出现涡旋征作为肠扭转手术指征的意义.方法 收集了从2006年1月至2011年4月期间临床拟诊肠扭转手术探查的39例患儿,术前均行CT检查.不告知临床资料,分别请3位高年资的CT诊断医师,3位普外科主治医师回顾性阅片.阅片的内容为是否有涡旋征、扭转的角度(扭转的角度以相差不超过180°为符合),记录结果,将肠扭转阅片结果与手术所见对照.计算诊断准确率、敏感率、特异率、Youden指数、阳性似然比、阴性似然比.结果 总准确率为81.7%,敏感率89.4%,特异率55.6%,Youden指数44.9%,阳性似然比2.18,阴性似然比0.21.6位医师阅片之间结果x2检验未见统计学差异.结论 单一出现涡旋征对肠扭转的诊断具有较高的敏感性;有肠梗阻症状,CT扫描出现涡旋征应该急诊手术;肠管或肠系膜的占位同时出现涡旋征应该急诊手术;旋转不良合并中肠扭转的涡旋征出现的位置可能会有变异;CT平扫不能准确反应肠扭转的角度.
目的 評估CT檢查單一齣現渦鏇徵作為腸扭轉手術指徵的意義.方法 收集瞭從2006年1月至2011年4月期間臨床擬診腸扭轉手術探查的39例患兒,術前均行CT檢查.不告知臨床資料,分彆請3位高年資的CT診斷醫師,3位普外科主治醫師迴顧性閱片.閱片的內容為是否有渦鏇徵、扭轉的角度(扭轉的角度以相差不超過180°為符閤),記錄結果,將腸扭轉閱片結果與手術所見對照.計算診斷準確率、敏感率、特異率、Youden指數、暘性似然比、陰性似然比.結果 總準確率為81.7%,敏感率89.4%,特異率55.6%,Youden指數44.9%,暘性似然比2.18,陰性似然比0.21.6位醫師閱片之間結果x2檢驗未見統計學差異.結論 單一齣現渦鏇徵對腸扭轉的診斷具有較高的敏感性;有腸梗阻癥狀,CT掃描齣現渦鏇徵應該急診手術;腸管或腸繫膜的佔位同時齣現渦鏇徵應該急診手術;鏇轉不良閤併中腸扭轉的渦鏇徵齣現的位置可能會有變異;CT平掃不能準確反應腸扭轉的角度.
목적 평고CT검사단일출현와선정작위장뉴전수술지정적의의.방법 수집료종2006년1월지2011년4월기간림상의진장뉴전수술탐사적39례환인,술전균행CT검사.불고지림상자료,분별청3위고년자적CT진단의사,3위보외과주치의사회고성열편.열편적내용위시부유와선정、뉴전적각도(뉴전적각도이상차불초과180°위부합),기록결과,장장뉴전열편결과여수술소견대조.계산진단준학솔、민감솔、특이솔、Youden지수、양성사연비、음성사연비.결과 총준학솔위81.7%,민감솔89.4%,특이솔55.6%,Youden지수44.9%,양성사연비2.18,음성사연비0.21.6위의사열편지간결과x2검험미견통계학차이.결론 단일출현와선정대장뉴전적진단구유교고적민감성;유장경조증상,CT소묘출현와선정응해급진수술;장관혹장계막적점위동시출현와선정응해급진수술;선전불량합병중장뉴전적와선정출현적위치가능회유변이;CT평소불능준학반응장뉴전적각도.
Objective To evaluate the single whirl sign in CT scan as operational indication of intestinal volvulus.Methods The abdominal CT findings and clinical data of 39 cases with suspected intestinal volvulus were collected from Jan 2006 to Apr 2011.Three senior CT diagnosticians were in vited to read the CT scan respectively without any clinical information.The whirl sign and twisting angle size were measured.After comparing with operational findings,diagnostic accuracy,sensitivity,specificity,Youden index,positive likelihood ratio and negative likelihood ratio were calculated.Results The diagnostic accuracy was 81.7%,the sensitivity was 89.4%,the specificity was 55.6%,the Youden index was 44.9%,the positive likelihood ratio was 2.18 and the negative likelihood ratio was 0.21.Conclusions Single whirl sign has more sensitivity in diagnosis of intestinal volvulus.Clinical signs of intestinal obstruction with whirl sign in CT scan are indications of emergency operation,and tumors in intestinal canal or mesentery with whirl sign also need emergency operation.The position of whirl sign may be distorted in patients with the intestinal malrotation.However,CT scan cannot show the twist angle of intestinal volvulus.