多层螺旋CT在诊断上腔静脉综合征中的应用

Application of multi-slice spiral CT in the diagnosis of superior vena cava syndrome

目的探讨多层螺旋CT(MSCT)对上腔静脉综合征(SVCS)的诊断价值。方法回顾性分析佳木斯大学附属第一医院CT室2014年9月至2016年5月经病理证实的120例肺癌患者的CT增强扫描资料,对MSCT拟诊为SVCS的33例患者均进行数字血管造影(DSA)检查,并对检查结果进行统计分析。结果 (1)120例肺癌患者中,MSCT拟诊为SVCS患者占27.5%(33/120),该33例患者经DSA诊断"金标准"检查证实与MSCT诊断符合率为100.00%(33/33),左肺癌6例,右肺癌27例。(2)33例SVCS患者中MSCT诊断轻-中度狭窄12例,重度19例,完全2例;DSA诊断轻-中度狭窄14例,重度18例,完全1例,且2种方法差异无统计学意义(χ2=0.51,P=0.847)。(3)33例SVCS患者中继发征象包括侧支循环10例,单纯胸壁水肿7例,侧支循环合并胸壁水肿10例,既无侧支循环又无胸壁水肿6例,上腔静脉梗阻程度与继发征象有关,差异有统计学意义(P<0.05)。结论 MSCT对SVCS的诊断具有临床应用价值,能够很好地评价梗阻程度,为临床下一步治疗提供良好的参考依据。

Objective To explore the value of muhi-slice spiral CT（MSCT） in diagnosing superior vena cava syndrome （SVCS）. Method Retrospective analysis of 120 cases of enhanced scanning whose patients were diagnosed with lung cancer （confirmed by pathology） in CT Room, first affiliated hospital of Jiamusi University. All patients with the first diagnosis of superior vena cava syndrome by MSCT were given with digitally angiography （DSA） inspection. By SPSS statistics data analysis, the ap- plied value of MSCT in the diagnosis of superior vena cava syndrome could be revealed. Results （ 1 ）Among the 120 cases of pa- tients with lung cancer, patients in diagnosis of SVCS by MSCT accounted for 27.5% （33/120）.The diagnostic coincidence rate of 33 patients confirmed by gold standard inspection DSA and by MSCT was up to 100% ,of which 6 cases in left lung,27 cases in right lung. （2）33 cases of SVCS by MSCT diagnosis in patients included mild-to-moderate narrow type （12 cases）, severe stenosis type （19 cases）, complete stenosis （2 cases） ;by DSA diagnosis in patients with mild-to-moderate narrow 14 cases, severe stenosis （ 18 cases ）, complete stenosis （ 1 case ） .The diagnosis difference was not statistically significant （χ2=0.51, P=0.847 ）. 33 cases with SVCS included 10 cases of collateral circulation, 7 cases of chest wall edema, 10 cases of both and 6 cases of neither, which indicated that the degree of superior vena cava obstruction was significantly associated with the secondary symptom （P〈0.05）. Conclusion MSCT in diagnosis of SVCS has clinical application value, and it can be a good evaluation of the degree of obstruction and provides good reference for the further clinical treatment.