摘要
目的:探讨多层螺旋CT(multi-slice spiral computed tomography,MSCT)增强表现在评价消化道浅表性病变内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术中出血的价值。方法:收集采取ESD治疗的连续99例消化道浅表性病变的临床资料,包括一般资料、MSCT平扫和增强表现包括形态学和强化效果的定量测量指标、手术结果、术中出血情况以及病理表现和结果等。根据术中出血情况将病例分为明显出血组与无明显出血组,采用两组独立样本t检验及秩和检验比较各指标是否具有统计学差异。应用受试者工作特征曲线(receiver operating characteristic curve,ROC),进一步确定其合理的最佳临界值(cutoff值)及灵敏度与特异度。结果:99例ESD发生术中明显出血6例(6/99,6.1%),经相应治疗后好转,无死亡病例。ESD术中出血在病变部位(贲门)、形态学参数包括高径和弓弦比,强化表现包括病变动脉期CT值、动脉期ΔCT值比值比、静脉期ΔCT值比值比、动脉期CT值比值比和静脉期CT值比值比的差异,具有统计学意义(P<0.05)。高径、弓弦比、病变动脉期CT值、静脉期ΔCT值比值比、静脉期CT值比值比的ROC曲线对ESD术中出血有一定的诊断效能。静脉期CT值比值比曲线下面积最大,其值为0.986。静脉期ΔCT值比值比、静脉期CT值比值比、高径、弓弦比、病变动脉期CT值的cutoff值、敏感度、特异度分别为1.638,83.3%,97.2%;1.442,83.3%,98.9%;7.55(mm),83.3%,75.3%;0.391,83.3%,63.9%;49.55(Hu),83.3%,76.1%。以静脉期CT值比值比诊断效能为佳。结论:部位、形态学和强化指标对ESD术中出血均有一定诊断意义。静脉期CT值比值比诊断效能最佳。MSCT对分析ESD术中出血具有重要价值。
Objective:To evaluate the value of enhanced MSCT manifestations in the assessment of intraoperative bleeding during endoscopic submucosal dissection(ESD)of gastrointestinal superficial lesions.Methods:The clinical materials of 99 consecutive cases of gastrointestinal superficial lesion which was treated with ESD have been collected retrospectively.The materials contain patients’general material,MSCT normal&enhanced scanning manifestations such as morphologic and the enhanced quantitative measurements,operation results,intraoperative bleeding situation and pathologic findings and so on.According to the intraoperative bleeding situation,the cases were divided into obvious-bleeding group and non-obvious-bleeding group.Independent two-sample t-test and rank-sum test were used to compare the differences between the two groups in each aspect.The receiver operating characteristic curve(ROC)was used to determine the reasonable optimal critical value(cutoff value),sensitivity and specificity.Results:Intraoperative bleeding occurred in 6 cases among the 99 cases(6/99,6.1%)and the bleeding was treated properly with no death case.Statistics show significant differences(P<0.05)between the two groups in the following aspects:the bleeding spot(Cardia),the morphological parameters such as height to diameter ratio,bow to string ratio and delta CT value ratios in both arterial phase and venous phase.The ROC of height to diameter ratio,bow to string ratio,arterial CT value and delta CT value ratio in venous phase have certain diagnostic effectiveness.The venous phase ratio has the biggest area under the curve,which is 0.986.The cutoff value,sensitivity and specificity of the venous phase,delta CT value ratio,the venous phase ratio,height to diameter ratio,bow to string ratio and the arterial CT value are respectively 1.638,83.3%,97.2%;1.442,83.3%,98.9%;7.55(mm),83.3%,75.3%;0.391,83.3%,63.9%;49.55(Hu),83.3%,76.1%.The diagnostic effectiveness of the venous phase ratio is the optimum.Conclusion:The location,morphological and enhancement measurements have some certain diagnostic significance in ESD bleeding.The venous phase ratio is the optimal manifestation.MSCT has significant value in the analysis of intraoperative bleeding in ESD surgery.
作者
王韦
Wang Wei(Department of Radiology,Yizheng Hospital of Nanjing Drum Tower Hospital Group,Nanjing,Jiangsu 211900)
出处
《现代医用影像学》
2022年第8期1387-1393,共7页
Modern Medical Imageology
