肠腔内造影CT对直肠癌术后吻合口漏的诊断价值

Diagnostic value of intra-intestinal angiography CT in patients with anastomotic leakage after rectal cancer resection

目的探讨泛影葡胺填充直肠盆腔CT平扫对直肠癌术后吻合口漏的诊断价值。方法回顾性收集2013年1月至2018年10月期间就诊于联勤保障部队第九〇〇医院普通外科且确诊为直肠恶性肿瘤并行直肠癌切除保肛手术的患者,所有患者在直肠癌术后第7天常规行影像学序贯检查,先行泛影葡胺灌肠造影检查,获得造影腹部X线平片,随即行盆腔CT平扫获得肠腔内造影CT图像。由2名高年资影像科医生进行阅片,计算单纯泛影葡胺灌肠造影和泛影葡胺填充直肠盆腔CT平扫诊断直肠癌术后吻合口漏的灵敏度、特异度、阳性预测值(PPV)和阴性预测值(NPV),并评价CT图像特征预测吻合口漏的灵敏度。结果单纯泛影葡胺灌肠造影诊断直肠癌术后吻合口漏的灵敏度、特异度、PPV和NPV分别为69.23%(18/26)、98.64%(218/221)、85.71%(18/21)和96.46%(218/226),肠腔造影CT上述指标分别为96.15%(25/26)、99.09%(219/221)、92.59%(25/27)和99.54%(219/220)。肠腔造影CT诊断吻合口漏的灵敏度和NPV高于单纯泛影葡胺灌肠造影(P<0.05)。通过肠腔内造影剂外漏诊断吻合口漏的灵敏度最高,达96.15%(25/26)。结论与单纯泛影葡胺灌肠造影相比,泛影葡胺填充直肠盆腔CT平扫诊断吻合口漏的灵敏度高,整体诊断效能较好;其中造影剂外漏是诊断吻合口漏的主要影像学特征,对于临床有一定指导意义。

Objective To investigate the diagnostic value of intra-intestinal angiography CT in patients with anastomotic leakage(AL) after rectal cancer resection. Methods Patients who admitted to The Department of General Surgery of The No. 900 Hospital of The Joint Logistic Team from January 2013 to October 2018, who were diagnosed with rectal cancer and underwent rectal cancer resection with sphincter preserving surgery, were retrospectively collected in the study. All patients underwent routine imaging examination on the 7 th day after rectal cancer operation. The retrograde contrast enema(RCE) was performed to obtain the abdominal X-ray film, then the pelvic CT scan was performed to get the CT image of the intestinal lumen. The films were reviewed by 2 senior radiologists, and the sensitivity, specificity,positive predictive value(PPV), and negative predictive value(NPV) of RCE and intra-intestinal angiography CT in the diagnosis of AL after rectal cancer resection were evaluated. Evaluated the sensitivity of the CT image feature to predict AL after rectal cancer resection. Results The sensitivity, specificity, PPV, and NPV of RCE in the diagnosis of AL after the rectal cancer resection were 69.23%(18/26), 98.64%(218/221), 85.71%(18/21), and 96.46%(218/226) respectively. The sensitivity, specificity, PPV, and NPV of intra-intestinal angiography CT were 96.15%(25/26), 99.09%(219/221), 92.59%(25/27), and 99.54%(219/220) respectively. The sensitivity and NPV of intra-intestinal angiography CT in diagnosis of AL were significantly higher than those of RCE(P<0.05). The sensitivity of contrast agent leakage to diagnosis of AL was the highest, reaching 96.15%(25/26). Conclusions The sensitivity of intra-intestinal angiography CT in the diagnosis of AL is high and the overall diagnostic efficiency is better than RCE, and the leakage of contrast agent is the main imaging feature of AL. It is significant to guide the clinical practice.