多层螺旋CT对食管鱼刺异物的诊断价值

Value of multi-slice spiral CT in diagnosis the detection of fish bone impaction in the esophagus

目的探讨MSCT对食管鱼刺异物的检出率及临床诊断价值。方法实验组：取3种鱼的鱼刺各30根，分为大、中、小鱼刺3组，3组鱼刺长度分别为（23．36±0．15）、（28．51±0．07）和（30．89±0．10）mm，直径分别为（4．49±0．31）、（1．78±0．09）和（0．49±0．07）mm。将鱼刺按照与食管长轴平行、垂直、斜行方式插入食管模型中，MSCT检查采用轴面扫描结合三维重组技术，观察MSCT和X线平片（CR和DR）对鱼刺的显示情况。临床组：回顾性分析20例经内镜或临床手术证实的食管鱼刺异物患者的资料，所有患者均行MSCT平扫，其中11例行X线平片（CR和DR）检查，15例行食管吞钡棉絮检查，17例行内镜检查，观察几种检查方法对鱼刺的显示情况。对不同方法对鱼刺显示情况的比较采用配对卡方检验。结果实验组：MSCT检出鱼刺90根（100％），X线平片（CR和DR）检出鱼刺60根（66．7％），MSCT对鱼刺的检出率高于X线平片（CR和DR）（Х^2=28．03，P〈0．01）。临床组：20例中，MSCT检出鱼刺20例，且清楚显示鱼刺的位置、大小及其与食管壁和邻近组织的关系；X线平片检出鱼刺2例，食管吞钡棉絮检出鱼刺9例，内镜检出鱼刺14例。MSCT对食管鱼刺异物检出率高于X线平片（CR和DR）检查（Х^2=7．11，P〈0．05）及食管吞钡棉絮检查（Х^2=4．17，P〈0．05），与内镜检查差异无统计学意义（Х^2=1．33，P〉0．05）。结论MSCT轴面扫描结合三维重组技术对食管鱼刺异物及其周围并发症的检出率高，可作为食管鱼刺异物的首选检查方法。

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus. Methods Experimental group： 30 fresh water fish bones from three variety classes were divided into three groups with length of（23.36±0. 15 ）, （28.51 ± 0. 07）and（30. 89 ±0. 10） ram,and diameter of （4.49 ±0. 31 ）, （ 1.78 ±0. 09） and （0. 49 ±0. 07） ram. The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique. MSCT with axial sean combined with three dimensional reconstruction technique and plain X-ray film （CR and DR） were used to examine the model. The relations of the number and rate offsh bones were compared between MSCT and X-ray film. Clinical group： MSCT imaging were performed in 20 eases proved by esophageal endoscope or elinieal operation, among which 11 eases received plain X-ray film （ CR and DR） , 15 eases received Barium-soaked cotton and 17 eases received endoscope. Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways. Results In experimental group： All the 90 cases（ 100% ） fish bones of three different species were clearly revealed on MSCT image; only 60 eases（66.7% ） fish bones were revealed by plain X-ray film（CR and DR）. The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film（ CR and DR） （ Х^2 = 28.03 ,P 〈 0. 01 ）. In clinical group： 20 eases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image. Two eases detected by plain X-ray film（ CR and DR） ;9 cases detected by Barium-soaked cotton; 14 eases detected by endoscopy. The number and rate of fish bones detected by MSCT was higher than that of plain X- ray film （ CR and DR） （ Х^2 = 7.11 , P 〈 0. 05 ） and Barium-soaked cotton （Х^2 = 4. 17, P 〈 0. 05 ）. Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus. MSCT could be used as the first examination of impacted fish bones in the esophagus.