MSCT在难以耐受食道造影的食管气管瘘患者诊治中的应用

杨英; 王旭; 刘戬; 秦芳; 邓刚; 常鑫; 金光暐; 尹晓明

doi:10.15953/j.1004-4140.2021.30.05.11

MSCT在难以耐受食道造影的食管气管瘘患者诊治中的应用

杨英^a,
王旭^a,
刘戬^a,
秦芳^b,
邓刚^a,
常鑫^a,
金光暐^a,
尹晓明^a

应急总医院 a)影像科;b)呼吸内科, 北京 100028

基金项目:

应急总医院局级科研资助项目（MSCT及其后处理在晚期纵隔恶性肿瘤并发食管气管瘘中的应用价值（K202017））。

详细信息

作者简介:
杨英,女,应急总医院影像科主治医师,主要从事胸部影像诊断研究,E-mail:yangying050701@sina.com;尹晓明^*,男,应急总医院影像科主任医师,主要从事神经及体部影像诊断研究,E-mail:yinxiaoming_1971@aliyun.com。

中图分类号: R814.42
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出版历程
- 收稿日期: 2021-04-15
- 网络出版日期: 2021-09-22

Role of MSCT in Patients Suffered Tracheoesophageal Fistula Who Cannot Tolerate Esophagography

a). Imaging Department;b). Respiration Department, Emergency General Hospital, Beijing 100028, China

摘要

摘要: 目的：探讨MSCT在老年或癌症晚期等难以耐受食道造影的食管气管瘘患者中的应用价值。方法：回顾性分析2016年至2020年在我院因高度怀疑食管气管瘘行MSCT及气管镜检查的病例，共纳入研究48例。所有图像经过横断位、冠状位、矢状位多平面、气管树容积再现及经气管树中心曲面重建后传至PACS，由两位医师盲法阅片，记录是否有食管气管瘘及阳性病例的大小；气管镜由操作者记录是否有食管气管瘘及阳性病例的大小。比较不同方法间对瘘口、大瘘口（直径>1cm）、小瘘口（直径<1cm）的检出率及MSCT与气管镜间大小比较。比较MSCT与气管镜检查对真阳性病例瘘口的大小。两位医师间采用Kappa一致性检验，不同评价方法间采用卡方检验，MSCT与气管镜检查的大小比较采用配对样本t检验，当P<0.05时有显著差异。结果：联合所有图像对所有食管气管瘘的检出率最高，其敏感性、特异性及准确性分别达93%、75%及86%，不同方法对所有瘘口的检出有显著差异，其中矢状位与横断位对瘘口的检出率较高。在所有阳性病例中不同方法间对大瘘口的检出率，各方法间有显著差异，其中联合所有图像对大瘘口的检出率达100%，矢状位与横断位对大瘘口的检出率较高；而对小瘘口的检出，各方法间无显著差异。在所有真阳性病例中，气管镜中所测量的瘘口大小（13.70±11.70）mm，高于MSCT中测量的瘘口的大小（10.83±10.15）mm，两者有显著差异。结论：MSCT及其常见后处理方法在难以耐受食道造影的食管气管瘘患者评估中起重要作用。
- 食管气管瘘 /
- 晚期肿瘤 /
- 多层螺旋计算机体层摄影
Abstract: Objective: To explore the value of MSCT used in elder patients or terminal-stage-cancer patients with tracheoesophageal fistula who can't tolerate esophagography. Methods: We performed retrospective analysis on 48 cases highly suspected of tracheoesophageal fistula who treated in our hospital and underwent MSCT and tracheoscopy during 2016-2020. All images were transmitted to PACS after the multiplanar reconstruction of axial, coronary, sagittal, volume reproduction of trachea tree and curved reconstruction of the central surface of the trachea tree. Two doctors read the film in blind method to record whether there was tracheoesophageal fistula and the size of positive cases while the operators did the record detected by tracheoscope. We compared the detection rate and size of the fistula, the big fistula (diameter>1cm), the small fistula (diameter<1cm) and also the size of fistulae in positive cases when used MSCT and tracheoscope respectively. Kappa consistency test was used between the two doctors, chi-square test was used among different evaluation methods while paired-samples t test was adopted to compare the size detected by MSCT and tracheoscope respectively. P<0.05 was indicative of a statistically significant difference. Results: The detection rate of tracheoesophageal fistula was the highest when combined with all the images, and the sensitivity, specificity and accuracy reached 93%, 75% and 86% respectively. There was significant difference in the detection rate of fistula among different methods and the detection rate of sagittal and axial images of the fistula was higher. The detection rate of the big fistula was significantly different among different methods in all positive cases. The detection rate of the big fistula was 100% by combining all the images and the detection rate of the sagittal and the transverse images was inferior to it. There was no significant difference among different methods applied in the detection of small fistula. Among all the positive cases, the size of the fistula measured in tracheoscope was 13.70mm±11.70mm, which was higher than that measured in the images of MSCT which was 10.83mm±10.15mm, there was significant difference between the two methods. Conclusion: MSCT and its routine post-processing methods play an important role in patients who cannot tolerate esophagography.
- tracheoesophageal fistula /
- advanced tumor /
- multislice spiral computed tomography

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