CT对绞窄性肠梗阻伴不可逆性缺血坏死的诊断价值

Diagnostic Value of CT for Differentiate Irreversible Ischemic Necrosis in Strangulated Ileus

目的:比较绞窄性肠梗阻不可逆性缺血坏死和可逆性缺血坏死患者术前计算机断层扫描(CT)特征的差异。方法:选择2013年2月至2016年12月我院收治的60例因绞窄性肠梗阻需行紧急手术者,其中30例为不可逆性缺血坏死(缺血组,n=30),30例为可逆性缺血坏死(非缺血组,n=30)。比较两组患者一般资料(年龄、性别、体质指数),术前生化指标(白细胞计数、尿素氮、C反应蛋白等)和影像学结果的差异。结果:两组患者白细胞计数、尿素氮、C反应蛋白等生化指标比较差异无统计学意义(P>0.05),缺血组患者手术时间和术后住院时间显著长于非缺血组(P<0.05)。单因素分析结果表明未增强肠道影像平均CT值≥16.5 HU、增强/未增强平均比值<1.5、肠系膜积液和游离腹膜液均与不可逆缺血性坏死显著相关(P<0.05)。ROC曲线分析表明未增强肠道影像平均CT值的特异度和敏感度分别为0.927和0.914,增强/未增强平均比值<1.5的特异度和敏感度分别为0.908和0.735。结论:除肠系膜积液或游离腹膜液之外,绞窄性肠梗阻患者的平均CT值对诊断不可逆性缺血坏死有一定参考价值。

Objective： To compare the differences of strangulated ileus with and without irreversible ischemic necrosis in preoperative computed tomography （CT） images. Methods： Sixty patients with strangulated ileus underwent emergency operations from February 2013 to December 2016 in our department were selected, including 30 patients with irreversible ischemic changes （ischemic group; n=30） and 30 patients with reversible ischemic changes during laparotomy （non-ischemic group; n=30）. The characteristics, preoperative clinical and images were compared between the ischemic and non-ischemic groups. Results： There was no significant difference in the biochemical indexes such as white blood cell count, urea nitrogen and C-reactive protein between the two groups （P〉0.05）. The operation time and postoperative hospital stay in the ischemic group were significantly longer than those of the non-ischemic group（P〈0.05）. Univariate analysis revealed that a mean CT value of intestine in an unenhanced image 16.5 HU （P〈0.001）, a mean CT value ratio of intestine （enhanced/tmenhanced image） 〈1.5 （P〈0.001）, presence of mesenteric fluid （P=0.005） and presence of free peritoneal fluid （P= 0.009） were associated with the ischemic necrosis. ROC curve analysis showed that the specificity and sensitivity of CT value of intestine （enhance） were 0.927 and 0.914, and the specificity and sensitivity of CT value ratio〈1.5 were 0.908 and 0.735, respectively. Conclusions： The mean CT value of a strangulated intestine may be a useful method for predicting irreversible ischemic changes in addition to the presence ofmesenteric fluid or free peritoneal fluid.