螺旋CT及后处理技术对食管闭锁并气管食管瘘的诊断价值

The value of helical CT and its postprocessing technique in the diagnosis of congenital esophageal atresia and tracheoesophageal fistula

目的 探讨螺旋CT对先天性食管闭锁并气管食管瘘的诊断价值。方法 对 6例临床疑为先天性食管闭锁与气管食管瘘的新生儿手术前行胸部正侧位片、插胃管及双层螺旋CT扫描 ,并进行多平面重建、三维重建和仿真内镜 ,所获得的结果与手术对照研究。结果 按照Gross的分类 ,5例为Ⅲ型 ,1例为Ⅰ型 ,多平面重建和三维重建所测两盲端的距离与手术结果基本相符 ,5例仿真内镜显示瘘管的开口。结论 螺旋CT扫描后多平面重建、三维重建和仿真内镜在显示和评价闭锁食管两盲端情况及气管食管瘘的位置是可靠的 。

Objective To evaluate the diagnostic value of helical CT in congenital esophageal atresia and tracheoesophageal fistula (CEA-TEF). Methods Chest radiography, catheter insertion into upper esophagus, and double-detector row CT scanning were performed in 6 neonates with clinically suspected CEA-TEF preoperatively. Then multi-plane reconstruction (MPR), three-dimensional CT, and virtual bronchoscopy were made on the workstation. The imaging manifestations were correlated with the surgical findings. Results According to Gross classification, five cases were type-Ⅲ and one was type-Ⅰesophageal atresia. All the MPR and three-dimensional CT imaging findings corresponded to the surgical findings. Virtual bronchoscopy images revealed the orifice of the fistula in five cases. Conclusion MPR, three-dimensional CT, and virtual bronchoscopy are reliable techniques for showing and assessing the distance between the two esophageal pouches, the presence and absence of fistula, and position of fistula in CEA-TEF. Helical CT can afford the reliable evidence in the preoperative assessment of CEA-TEF and accurate establishment of surgical plan.