Role of MSCT in Patients Suffered Tracheoesophageal Fistula Who Cannot Tolerate Esophagography
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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。
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关键词:
- 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. -
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[1] REED M F, MATHISEN D J. Tracheoesophageal fistula[J]. Chest Surgery Clinics of North America, 2003, 13(2):271-289.
[2] BOLCA C, PAVALOIU V, FOTACHE G, et al. Postintubation tracheoesophageal fistula-diagnosis, treatment and prognosis[J]. Chirurgia (Bucharest, Romania:1990), 2017, 112(6):696-704.
[3] LEE S. Basic knowledge of tracheoesophageal fistula and esophageal atresia. advances in neonatal care[J]. Official Journal of the National Association of Neonatal Nurses, 2018, 18(1):14-21.
[4] GARGE S, Rao K L N, BAWA M. The role of preoperative CT scan in patients with tracheoesophageal fistula:A review[J]. Journal of Pediatric Surgery, 2013, 48(9):1966-1971.
[5] SANTOSH K M,KUSHALJEET S S, NARASIMHAN K L, et al. Role of preoperative 3D CT reconstruction for evaluation of patients with esophageal atresia and tracheoesophageal fistula[J]. Pediatric Surgery International, 2012, 28(10):961-966.
[6] 方涛. 多层螺旋CT检查对食管癌放疗后并发食管瘘小瘘口的诊断价值[J]. 中国基层医药, 2019, 26(11):1297-1300. FANG T. Clinical value of multi-slice spiral CT in the diagnosis of esophageal fistula after radiotherapy for esophageal cancer[J]. Chinese Journal of Primary Medicine and Pharmacy, 2019, 26(11):1297-1300. (in Chinese)
[7] MICHAEL J S, BRIAN L, MARK G S, et al. Symptom management in patients with lung cancer:Diagnosis and management of lung cancer, 3rd ed:American college of chest physicians evidence-based clinical practice guidelines[J]. Chest, 2013, 143(S5):e455S-e497S.
[8] HAGENDOORN J, SCHIPPER M E I, CLOIN A, et al. A patient with tracheoesophageal fistula and esophageal cancer after radiotherapy[J]. Nature Reviews Gastroenterology and Hepatology, 2010, 7(12):702-706.
[9] BERKMEN Y M, AUH Y H. CT diagnosis of acquired tracheoesophageal fistula in adults[J]. Journal of Computer Assisted Tomography, 1985, 9(2):302-304.
[10] 贺新华, 曹和涛. 胸部体检人群气管憩室变化的MSCT随访观察[J]. 放射学实践, 2021, (1):82-87. HE X H, CAO H T. Follow-up observation of trachea diverticulum changes by MSCT in patients undergoing chest physical examination[J]. Radiologic Practice, 2021 , (1):82-87. (in Chinese).
[11] RAJAN S. Management of acquired benign tracheoesophageal fistulae[J]. Thoracic Surgery Clinics, 2018, 28(3):385-392.
[12] 王洪武, 李冬妹, 张楠, 等. 气管内覆膜金属支架置入治疗食管气管瘘[J]. 中华结核和呼吸杂志, 2013, 36(5):390-392. WANG H W, LI D M, ZHANG N, et al. Endotracheal covered metal stent placement for the treatment of esophago tracheal fistula[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2013, 36(5):390-392. (in Chinese).
[13] 丛明华, 金发光, 柯明耀, 等. 继发性气道-消化道瘘介入诊治专家共识[J]. 中华肺部疾病杂志(电子版), 2018, (2):131-138. CONG M H, JIN F G, KE M Y, et al. Expert consensus on interventional diagnosis and treatment of secondary airway gastrointestinal fistula[J]. Chinese Journal of Lung Diseases (Electronic Edition), 2018, (2):131-138. (in Chinese). [14] 杨英, 邓茂松, 祖德贵, 等. 多排螺旋CT在气管支架随访中的应用[J]. CT理论与应用研究, 2016, 25(5):593-599. DOI:10.15953/j.1004-4140.2016.25.05.12. YANG Y, DENG M S, ZU D G, et al. The value of multi-slice spiral CT in follow-up of the tracheal stent[J]. CT Theory and Applications, 2016, 25(5):593-599. DOI:10.15953/j.1004-4140.2016. 25.05.12. (in Chinese).
[15] 方林, 李亮. 自适应统计迭代重建技术在降低CT辐射剂量中的应用进展[J]. CT理论与应用研究, 2013, 22(2):207-214. FANG L, LI L. Application progress of adaptive statistical iterative reconstruction in reducing radiation dose[J]. CT Theory and Applications, 2013, 22(2):207-214. (in Chinese).
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