| 柴亚如,高剑波,吕培杰,梁盼,邢静静.CT预估保守治疗闭襻性肠梗阻效果[J].中国医学影像技术,2022,38(11):1666~1669 |
| CT预估保守治疗闭襻性肠梗阻效果 |
| CT findings for predicting effect of conservative treatment of closed loop small bowel obstruction |
| 投稿时间：2022-06-13 修订日期：2022-08-12 |
| DOI：10.13929/j.issn.1003-3289.2022.11.016 |
| 中文关键词: 肠梗阻 体层摄影术,X线计算机 保守疗法 |
| 英文关键词:intestinal obstruction tomography, X-ray computed conservative treatment |
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| 中文摘要: |
| 目的 观察CT预估保守治疗闭襻性肠梗阻效果的效能。方法 回顾性分析95例经CT诊断并接受保守治疗的无肠缺血征象闭襻性肠梗阻患者；以治疗后梗阻症状好转、随访1个月内无进展、碘剂消化道造影或CT证实梗阻缓解为治疗成功，反之为治疗失败，对比其临床资料及CT所见，分析以CT征象预估保守治疗闭襻性肠梗阻成功的效能。结果 保守治疗成功31例（成功组），治疗失败64例（失败组），组间CT所见梗阻程度、肠系膜水肿、积粪征及移行点距离差异均有统计学意义（P均<0.05）。多因素分析结果显示，积粪征[OR=3.19，95%CI（1.15，8.87），P=0.026]和移行点距离[OR=7.35，95%CI（2.82，31.02），P=0.002]是保守治疗成功的影响因素。以受试者工作特征（ROC）曲线确定移行点距离预测闭襻性肠梗阻保守治疗成功的最佳截断值为9.7 mm。以积粪征、移行点距离（≥ 9.7 mm）预测闭襻性肠梗阻保守治疗成功的敏感度分别为48.39%（15/31）和87.10%（27/31），特异度为75.00%（48/64）和56.25%（36/64）；二者联合的敏感度、特异度分别为35.48%（11/31）、87.50%（56/64）。结论 根据CT所见积粪征和梗阻移行点距离可在一定程度上预估保守治疗闭襻性肠梗阻的效果。 |
| 英文摘要: |
| Objective To explore the value of CT finding for predicting the effect of conservative treatment of closed loop small bowel obstruction.Methods Data of 95 patients with CT diagnosed closed loop small bowel obstruction without signs of intestinal ischemia and then undergoing conservative treatments were retrospectively analyzed. Taken the symptoms improved immediately after treatment, no progress during 1 month's follow-up, and obstruction relief confirmed with iodine gastroenterography or CT as the standards of successful treatment, the clinical data and CT findings before treatment of successful cases and failure ones were compared, and the efficacy of CT findings for predicting the success of conservative treatment of closed loop small bowel obstruction was observed.Results Conservative treatment was successful in 31 cases (successful group) and failed in 64 cases (failure group). There were significant differences of the degree of obstruction, mesenteric haziness, feces sign and distance between the transition zones between groups (all P<0.05). The results of multivariate analysis showed that feces sign (OR=3.19, 95%CI[1.15, 8.87], P=0.026) and distance between the transition zones (OR=7.35, 95%CI[2.82, 31.02], P=0.002) were the impact factors of the success of conservative treatment. Based on receiver operating characteristic (ROC) curve, the optimal cut-off value of distance between the transition zones for predicting the success of conservative treatment of closed loop small bowel obstruction was 9.7 mm. The sensitivity of feces sign and distance between the transition zones (≥ 9.7 mm) for predicting successful conservative treatment was 48.39% (15/31) and 87.10% (27/31), and the specificity was 75.00% (48/64) and 56.25% (36/64), respectively, while the sensitivity and specificity of combination of the above two was 35.48% (11/31) and 87.50% (56/64), respectively.Conclusion The effect of conservative treatment of closed loop small bowel obstruction could be predicted to a certain extent according to the feces sign and distance between the transition zones on CT images. |
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