七种腹部CT征象在腹腔镜下ROUX-EN-Y术后腹内疝的诊断中的应用

The application of seven CT Signs on the diagnosis of internal hernia after ROUX-EN-Y operation

目的评价7种腹部CT征象在腹腔镜下ROUX-EN-Y术后腹内疝诊断中的敏感性和特异性。方法选取2009年1月至2015年1月桂林医学院附院行腹腔镜下ROUX-EN-Y术患者56例,术后并发腹内疝并经再次手术证实的患者28例为观察组;术后未并发腹内疝并经再次手术证实的患者28例为对照组。由三位影像医师对各例患者的再次手术前腹部CT进行阅读分析,分别记录7种征象的有无,7种征象为:肠系膜旋转征,小肠梗阻,飓风眼征,蘑菇征,聚集的肠袢,肠系膜上动脉后位小肠,右位吻合口。将结果进行诊断的敏感性和特异性分析。结果肠系膜旋转征是内疝的最佳独立预测因素,其敏感性75%,71%,84%,特异性分别为96%,87%,74%。其联合蘑菇征可以提高对内疝诊断的灵敏性,分别为85%、89%、92%,但特异性有所降低,分别为85%、87%、68%。结论肠系膜旋转征是腹腔镜ROUX-EN-Y胃肠旁路手术的最佳独立诊断因素。联合其他征象时可以更好的为影像医师诊断术后内疝提供依据,降低漏诊和误诊率。

Objective To evaluate the sensitivity and specificity of seven CT signs on the diagnosis of internal hernia after ROUX-EN-Y operation. Methods Select 56 patients who received ROUX-EN-Y operation in affiliated hospital of Guilin medical university between January 2009 and January 2015. 28 patients with surgically proven internal hernia after laparoscopic Roux-en-Y operation were included in observation group, and 28 patients who had undergone Roux-en-Y operation but did not have internal hernia at reoperation were noted as control group. Every patients＇ pre-reoperative CT scan were reviewed by three radiologists for the presence and recorded that whether the following 7 CT signs existed： swirled appearance of mesenteric, mushroom shape of hernia, tubular distal mesenteric fat surrounded by bowel loops, small- bowel obstruction, clustered loops of small bowel, small bowel posterior to the superior mesenteric artery, and right-sided location of the distal jejunal anastomosis. After that, the sensitivity and specificity of diagnosis was analyzed. Result Mesenteric swirl was the best single predictor of internal hernia; its sensitivity were 75% , 71% and 84% , and specificity were 96% , 87% and 74%. The combination of swirled mesentery and mushroom shape of the mesentery improved the sensitivity compared to swirled mesentery alone, were 85% , 89% and 92% , hut at the expense of specificity： 85% , 87% and 68%. Conclusion Mesenteric swirl is the best independent indicator of internal hernia after laparoscopic Rouxen-Y operation. It can provide even better evidence for doctors to diagnose internal hernia when combined with mushroom shape of the mesentery and decrease the missed and error diagnosis rate.