中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2010年
4期
214-218,后插3
,共6页
刘炜%秦明伟%薛华丹%孙昊%王萱%陈钰%苏佰燕%金征宇%陆星华%钱家鸣%朱峰%李玥%王沄%张晓娜%张云庆
劉煒%秦明偉%薛華丹%孫昊%王萱%陳鈺%囌佰燕%金徵宇%陸星華%錢傢鳴%硃峰%李玥%王沄%張曉娜%張雲慶
류위%진명위%설화단%손호%왕훤%진옥%소백연%금정우%륙성화%전가명%주봉%리모%왕운%장효나%장운경
Crohn病%多层螺旋CT%回-结肠吻合术%复发
Crohn病%多層螺鏇CT%迴-結腸吻閤術%複髮
Crohn병%다층라선CT%회-결장문합술%복발
Crohn's disease%Multidetector computed tomography%Ileocolic anastomosis%Recurrence
目的 探讨多层螺旋CT小肠重建技术在Crohn病术后患者回-结肠吻合口复发评价中的应用价值.方法 31例曾行小肠及部分结肠切除并回-结肠吻合、经手术病理诊断的Crohn病患者,口服2.5%甘露醇后应用64层螺旋CT行腹盆扫描,包括平扫、动脉期和门脉期扫描.利用门脉期图像,结合多平面重建技术,观察吻合口CT异常征象.以结肠镜、手术病理及临床活动指数评分为依据判断吻合口复发和正常,将患者分为活动组和静息组,分析CT征象对于判断复发的敏感性、特异性、准确性、阳性预测值和阴性预测值.结果 活动组和静息组患者分别有26例和5例.活动组有11例(42%)患者肠系膜淋巴结短径＞1 cm,8例(31%)吻合口周围瘘,静息组患者均无上述征象,但两组间差异无统计学意义(P＞0.05).活动组有16例(62%)吻合口壁厚＞6 mm、19例(73%)吻合口明显强化、14例(54%)强化后呈分层状及20例(77%)吻合口周围索条,静息组患者均无上述征象,两组间差异有统计学意义(P均＜0.05).如果肠系膜淋巴结短径＞1 cm、吻合口周围瘘、吻合口壁厚＞6 mm、吻合口明显强化、强化后呈分层状、吻合口周围索条6种CT征象中出现2种诊断吻合口复发,其敏感性为88%,特异性100%,阳性预测值100%,阴性预测值63%,准确性90%.CT诊断吻合口狭窄的准确性仅53%.结论 Crohn病术后患者回-结肠吻合口复发有较客观和特异性的CT表现,CT小肠重建技术可用于判断吻合口复发.
目的 探討多層螺鏇CT小腸重建技術在Crohn病術後患者迴-結腸吻閤口複髮評價中的應用價值.方法 31例曾行小腸及部分結腸切除併迴-結腸吻閤、經手術病理診斷的Crohn病患者,口服2.5%甘露醇後應用64層螺鏇CT行腹盆掃描,包括平掃、動脈期和門脈期掃描.利用門脈期圖像,結閤多平麵重建技術,觀察吻閤口CT異常徵象.以結腸鏡、手術病理及臨床活動指數評分為依據判斷吻閤口複髮和正常,將患者分為活動組和靜息組,分析CT徵象對于判斷複髮的敏感性、特異性、準確性、暘性預測值和陰性預測值.結果 活動組和靜息組患者分彆有26例和5例.活動組有11例(42%)患者腸繫膜淋巴結短徑＞1 cm,8例(31%)吻閤口週圍瘺,靜息組患者均無上述徵象,但兩組間差異無統計學意義(P＞0.05).活動組有16例(62%)吻閤口壁厚＞6 mm、19例(73%)吻閤口明顯彊化、14例(54%)彊化後呈分層狀及20例(77%)吻閤口週圍索條,靜息組患者均無上述徵象,兩組間差異有統計學意義(P均＜0.05).如果腸繫膜淋巴結短徑＞1 cm、吻閤口週圍瘺、吻閤口壁厚＞6 mm、吻閤口明顯彊化、彊化後呈分層狀、吻閤口週圍索條6種CT徵象中齣現2種診斷吻閤口複髮,其敏感性為88%,特異性100%,暘性預測值100%,陰性預測值63%,準確性90%.CT診斷吻閤口狹窄的準確性僅53%.結論 Crohn病術後患者迴-結腸吻閤口複髮有較客觀和特異性的CT錶現,CT小腸重建技術可用于判斷吻閤口複髮.
목적 탐토다층라선CT소장중건기술재Crohn병술후환자회-결장문합구복발평개중적응용개치.방법 31례증행소장급부분결장절제병회-결장문합、경수술병리진단적Crohn병환자,구복2.5%감로순후응용64층라선CT행복분소묘,포괄평소、동맥기화문맥기소묘.이용문맥기도상,결합다평면중건기술,관찰문합구CT이상정상.이결장경、수술병리급림상활동지수평분위의거판단문합구복발화정상,장환자분위활동조화정식조,분석CT정상대우판단복발적민감성、특이성、준학성、양성예측치화음성예측치.결과 활동조화정식조환자분별유26례화5례.활동조유11례(42%)환자장계막림파결단경＞1 cm,8례(31%)문합구주위루,정식조환자균무상술정상,단량조간차이무통계학의의(P＞0.05).활동조유16례(62%)문합구벽후＞6 mm、19례(73%)문합구명현강화、14례(54%)강화후정분층상급20례(77%)문합구주위색조,정식조환자균무상술정상,량조간차이유통계학의의(P균＜0.05).여과장계막림파결단경＞1 cm、문합구주위루、문합구벽후＞6 mm、문합구명현강화、강화후정분층상、문합구주위색조6충CT정상중출현2충진단문합구복발,기민감성위88%,특이성100%,양성예측치100%,음성예측치63%,준학성90%.CT진단문합구협착적준학성부53%.결론 Crohn병술후환자회-결장문합구복발유교객관화특이성적CT표현,CT소장중건기술가용우판단문합구복발.
Objective To determine the utility of computed tomographic (CT) enteroclysis for characterization of the status of the anastomotic site in patients with Crohn's disease (CD) who have previously undergone ileocolic resection. Methods Totally 31 CD patients who had previously undergone ileocolic resection were enrolled in the study. After having been orally administered with isosmotic mannitol, the patients received CT scanning including plain scan, arterial phase scan, and portal venous phase scan. The abnormal CT findings were analyzed based on portal venous phase images. CT enteroclysis findings in 31 patients were evaluated by two radiologists in consensus. Endoscopic findings, histopathologic findings, and/or the Crohn's disease activity index (CDAI) were used as the reference criteria. Associations between CT enteroclysis findings and anastomotic site status were assessed. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT enteroclysis for the diagnosis of normal anastomosis versus anastomotic recurrence were estimated. Results Twenty-six cases and 5 cases were diagnosed as disease recurrence and normal anastomosis, respectively. In the disease recurrence group, 11 patients (42%) had lymphadenopathy (diameter＞ 1 cm) and 8 patients (31%) had peri-anastomotic fistulas, which were absent in normal anastomosis group, but the difference was not significant Anastomotic wall thickening more than 6 mm, marked mucosal enhancement, stratification, and peri-anastomotic stranding were found in 16 (62%), 19 (73%), 14 (54%), and 20 (77%) cases, respectively, in disease recurrence group, which were absent in normal anastomosis group ( all P ＜ 0.05 ). When the diagnosis of anastomotic recurrence was based on more than two of the following six variables, including lymphadenopathy, peri-anastomotic fistulas, anastomotic wall thickening more than 6 mm, marked mucosal enhancement, stratification, and peri-anastomotic stranding, its sensitivity, specificity, postive predictive value, negative predictive value, and accuracy yielded 88%, 100%, 100%, 63%, and 90%, respectively. The diagnostic accuracy of anostomotic stenosis with CT was only 53%. Conclusion CT enteroclysis yields objective and relatively specific morphologic criteria that help differentiate between recurrent disease and normal at the anastomotic site after ileocolic resection for CD.
