选择性小肠造影对肠梗阻诊断的影像学价值:98例病例分析

Diagnostic value of selective small bowel enteroclysis in imageology of intestinal obstruction: clinical analysis of 98 cases

目的:通过对比分析肠梗阻患者的选择性小肠造影结果与出院诊断结果的一致性程度,探讨选择性小肠造影对肠梗阻的诊断价值及影响该检查方法效果的因素,以提高选择性小肠造影对肠梗阻的诊断效力。方法:选择性小肠造影是利用具有治疗作用的较长的经鼻小肠减压管对小肠局部进行造影观察。总结2008年4月至2012年4月在北京大学第三医院消化科进行选择性小肠造影的98例患者,对照选择性小肠造影与出院诊断的结果,通过诊断一致性评分进行诊断效能评估。诊断一致性评分分为5级:0分,选择性小肠造影无任何意义;0.25分,能够确定肠梗阻存在;0.50分,能够提示梗阻部位、范围和程度的某部分;0.75分,能够明确梗阻部位、范围、程度,并能提出可疑病因,且与最终出院诊断接近;1.00分,能够明确梗阻部位、程度、范围及梗阻原因,且与出院诊断完全一致。结果:在98例住院患者中,入院诊断以术后肠梗阻比例最高,占53.1%;出院诊断以粘连性肠梗阻者最多,占50%。肠梗阻以回肠梗阻(47.6%)、多发性肠梗阻(41.7%)、不完全性肠梗阻(59.5%)较多。影像学表现以肠道粘连、狭窄为主(61.9%)。在诊断一致性评分中,得分为0.75和1.00分的具有较高一致性的患者为50例,得分为0和0.25的具有较低一致性的患者为25例,两组间差异有统计学意义(P=0.004)。结论:经鼻肠减压管选择性小肠造影对肠梗阻患者具有较高的影像诊断价值,突破了传统小肠气钡双重造影在肠梗阻方面的应用禁忌,在梗阻部位、范围、程度及病因分析方面均具有较高的诊断一致性。影响诊断价值的因素主要是置管的位置,故动态监测至为重要。

Objective：To improve the diagnosticability of selective enteroclysis in the area of intestinal obstruction,by reviewing the cases of selective intestinal enteroclysis through a naso-intestinal decompression tube,and evaluating its diagnostic concordance level and the influence factors. Methods： The selective enteroclysis was different from traditional enteroclysis; it utilized a naso-intestinal decompression long tube to perform local intestinal opacification. In the four years between Apr. 2008 and Apr. 2012,98 cases of selective intestinal enteroclysis were analyzed retrospectively,and diagnostic concordance value was made between the radiologic diagnosis and the final clinical diagnosis recorded in the medical history according to an evaluating criterion. Five scores were used in the evaluating system： 0 meant that the enteroclysis had no valuable information to provide; 0. 25 meant that the enteroclysis could prompt the occurring of obstruction,but could not provide the information of location and cause; 0. 50 meant that the enteroclysis could find the location of obstruction,but could not determine the cause; 0. 75 meant that the enteroclysis could provide some valuable analysis of the causes of the obstruction,and very close to the final clinical diagnosis; 1. 00 meant that the complete concordance between the enteroclysis diagnosis and the final clinical diagnosis. The influence factors would also be considered to improve the competence of the selective enteroclysis in the diagnosis of intestinal obstruction. Results： In the 98 cases,53. 1%had definite abdominal operative history. The most common cause of obstruction was conglutination between intestinal loops when discharged from hospital,almost occupying 50%. In this group of cases,the most common types were ileum obstruction（47. 6%）,multiple location obstruction（41. 7%） and incomplete obstruction（59. 5%）. Conglutination and stricture of the intestinal was the common radiologic appearance（61. 9%）. There were 50 cases with higher concordance scoring 0. 75 or 1. 00,in comparison,there were 25 cases with lower concordance scoring 0 or 0. 25. The difference between the two groups had statistical significance. Conclusion： As a combination of traditional enteroclysis and naso-intestinal decompression tube,selective intestinal enteroclysis could exert higher diagnostic ability than that of traditional enteroclysis and also could break through the limitations of traditional enteroclysis in the condition of intestinal obstruction. This method has higher diagnostic concordance and could provide valuable information in obstruction location,extent,severity and possible causes. The main factor influencing the effectiveness of the examination is the location of the decompression tube and dynamic observation would be very helpful and important.