低张水灌肠低剂量MDCT在大肠疾病筛查中的应用价值

Application value of hypotonic water enema low-dose MDCT in screening for large intestine diseases

目的:探讨低张水灌肠低剂量MDCT在大肠疾病体检筛查中的临床应用价值。方法:156例体检者分别进行大肠低剂量MDCT扫描(A组)、钡剂灌肠(B组)和内镜检查(C组)。以病理或临床诊断作为参照,比较3种检查方法检出大肠病变的敏感性和特异性。以操作难度、配合难度、舒适感、检查时间和可能性伤害共5个问题设计调查表来评估患者对3种检查方法的可耐受性,并进行统计学分析。结果:156例中经病理和临床确诊的大肠病变63例,其中肿瘤17例、炎性病变45例、肠套叠1例。A、B、C三组检出病变的敏感度和特异度分别为52.4%和95.7%、6.3%和92.5%,85.7%和97.8%,三组间敏感度的差异有统计学意义(P<0.05),特异度的差异无统计学意义(P>0.05)。患者对3种检查方法的耐受性低的例数分别为34例、22例和122例,患者对内镜检查的可耐受性显著低于MDCT和钡剂灌肠(P<0.05)。结论:低张水灌肠低剂量MDCT技术能较好地显示大肠的解剖结构、可行性高,可为内镜和钡剂灌肠检查提供补充信息,可推荐作为大肠病变体检筛查的常规检查方法。

Objective： The purpose of the present study was to analyze the clinical value of hypotonic water enema low-dose MDCT in screening for large intestine diseases. Methods：One hundred and fifty-six volunteers for healthy examination were selected in this study. All the volunteers underwent hypotonic water enema low-dose MDCT （group A）, barium enema （group B） and intestinal endoscopy （group C） examinations. With the pathologic findings or clinical diagnoses as ref- erence,the sensitivity and specificity of the three methods in detecting colorectal diseases were compared. A questionnaire （including operation difficulty, patient cooperation, examination comfort, examination time and possible injury） was designed to evaluate and compare the individual tolerance to each of the examination. Results：Of the 156 volunteers, there were 63 cases with colorectal diseases, including tumors （n= 17）, inflammatory bowel diseases （IBD） （n=45） and intussusception （n= 1）. The sensitivity and specificity for detecting colorectal diseases in group A,B,C were 52.4% and 95.7%,6.3% and 92.5 %,85.7 % and 97.8 %, respectively. There was significant difference in the sensitivity among the three groups （P〈 0.05）, but there was no statistical difference in the specificity among the three groups （P〉0.05）. In group A, B and C, the number of volunteers with poor tolerance to the examination was 34,22 and 122. Compared with MDCT and barium enema, the tolerance of intestinal endoscopy was significant lower （P〈0.05）. Conclusiom Hypotonic water enema low-dose MDCT can clearly display anatomical structure of large intestine with higher feasibility,and can be used as an examination method for physical examination and screening of large intestine, which provides valuable supplementary information for endoscopy and barium enema. It can be recommended as one of the routine screening methods for large intestine diseases.