急诊增强CT对腹部钝性单纯性肠及肠系膜损伤手术干预的预测价值

The predictive value of emergency contrast-enhanced CT for simple blunt bowel and/or mesenteric injuries requiring surgical intervention

目的:探讨急诊增强CT对腹部钝性单纯性肠及肠系膜损伤(BBMI)手术干预的预测价值。方法:回顾性搜集行急诊腹部增强CT检查,手术或随访证实的单纯性BBMI患者54例,其中31例行手术治疗(手术组),23例行保守治疗(保守治疗组)。由2位影像医师分析临床表现及CT征象,并计算基于影像学肠道损伤评分,即Faget评分和Mc Nutt评分(BIPS)。采用受试者工作特征(ROC)曲线分析各指标的预测效能,CT判读肠道损伤部位与手术结果进行对照研究。结果:单因素分析结果显示肠壁中断、系膜缘及游离气腹、肠系膜血管中断/活动性出血、节段肠道强化减低、非局灶肠壁增厚的发生率在手术组与保守治疗组间差异有统计学意义(P<0.05);Faget评分、BIPS评分在两组间差异亦有统计学意义(P<0.05)。ROC曲线分析结果显示Faget评分的预测效能最佳,曲线下面积为0.928,最佳阈值为8.5,敏感度和特异度分别为80.6%、95.7%。CT诊断BBMI肠道损伤部位的敏感度、特异度、准确度、阳性及阴性预测值、阳性及阴性似然比分别为97.2%、87.5%、90.3%、76.1%、98.7%、7.78、0.03。结论:急诊增强CT对腹部钝性单纯性BBMI手术干预与否及损伤部位定位诊断有较高的预测价值,对临床治疗方案的制定有重要指导意义。

Objective:To investigate the predictive value of emergency contrast-enhanced CT in the detection of blunt bowel and/or mesenteric injuries(BBMI) requiring surgical intervention.Methods:A retrospective analysis of blunt abdominal trauma by emergency enhanced CT examination from January 2018 to March 2022 was conducted, and 54 patients(31 in the surgical treatment group and 23 in the conservative treatment group) with simple BBMI who were confirmed by surgery or follow-up imaging were involved.Clinical manifestations and CT imaging findings were compared between the two groups.A bowel injury scoring, such as the CT-based Faget score or the clinical and CT-based Mc Nutt score(BIPS),was calculated.A receiver operating characteristic(ROC) curve was used to analyze the predictive efficacy of each index.Intestinal injury sites displayed on CT images were compared with the surgical findings.Results:Univariate analysis showed that there were significant differences in the incidence of intestinal wall interruption, mesenteric margin and free pneumoperitoneum, mesenteric vascular interruption/active bleeding, decreased segmental intestinal enhancement, and non-focal intestinal wall thickening between the surgery group and the conservative treatment group(P<0.05).There were also significant differences in the Faget score and BIPS score between the two groups(P<0.05).The ROC curve revealed the superiority of the Faget score over the others, with the optimal threshold of 8.5,the area under the curve(AUC) of 0.928,the sensitivity, and specificity of 80.6% and 95.7%,respectively.The sensitivity, specificity, accuracy, positive and negative predictive value, positive and negative likelihood ratio of CT diagnosis for BBMI intestinal injury site were 97.2%,87.5%,90.3%,76.1%,98.7%,7.78 and 0.03,respectively.Conclusion:Emergency contrast-enhanced CT has a high predictive value of the need for surgical intervention and the localization diagnosis of the injury site in blunt and simple BBMI,which is of great significance in guiding clinical decisions.