325例肠梗阻影像学诊断价值分析及误诊体会

Analysis of imaging diagnostic value and misdiagnosis of 325 cases of intestinal obstruction

目的:探讨325例肠梗阻影像学诊断价值和误诊原因。方法:选取2018年5月—2023年3月于江油市中医医院确诊的325例肠梗阻病例,以临床确定结果为金标准,考察终末影像诊断结论建立各类型梗阻诊断效能分析模型,并从终末、单次和首次影像学诊断三个维度分析诊断准确率、灵敏度和特异度,探讨混杂因素干扰可能。结果:各型肠梗阻影像学诊断价值效能和灵敏度、特异度存在差异,本组首次影像准确率仅为58.15%,单次影像符合率68.33%,低于终末诊断的84.00%,终末影像诊断与确定诊断之间无显著差异(P> 0.01);血运障碍型诊断效能低于其他各型。影像医师、图像质量和临床医师参与了影像诊断价值的他因干扰。结论:影像学具有较高的肠梗阻诊断价值,除外血运障碍型起病危急状态下的检查急迫性和方式选择局促性,多种因素参与影像学诊断价值构成。

Objective To investigate the imaging diagnostic value and misdiagnosis causes of 325 cases of intestinal obstruction.Methods A total of 325 cases of intestinal obstruction diagnosed in Jiangyou Hospital of Traditional Chinese Medicine from May 2018 to March 2023 were selected.Clinical diagnosis was taken as the gold standard,and the diagnostic efficacy analysis model for various types of obstruction was established by examining the diagnosis conclusions of terminal imaging.The diagnostic coincidence rate,sensitivity and specificity were analyzed from three dimensions of terminal,single and first imaging diagnosis,and the possibility of confounding factors was explored.Results There were differences in the efficacy,sensitivity and specificity of imaging diagnosis of various types of intestinal obstruction.The accuracy of the first image diagnosis was only 58.15%,and the coincidence rate of the single image was 68.33%,which was lower than that of the final diagnosis(84.00%).There was no significant difference between the final image diagnosis and the confirmed diagnosis(P>0.01).The diagnostic efficiency of vascular intestinal obstruction was lower than that of other types.The radiologist,image quality,and clinician were involved in the diagnostic value of imaging due to interference.Conclusion Imaging has a high diagnostic value of intestinal obstruction,except for the urgency of examination and the limited choice of mode in the critical state of the onset of the vascular intestinal obstruction.