摘要
目的:探讨上消化道钡餐造影联合 64 排螺旋CT在肠系膜上动脉综合征(SMAS)中的诊断价值.方法:回顾性分析2020 年 1 月—2023 年 1 月贵港市人民医院收治的 60 例疑似SMAS患者,行 64 排螺旋CT检查和上消化道钡餐造影检查,并以肠系膜上动脉造影检查结果为标准对照,进行一致性分析,计算准确率、灵敏度、特异度、误诊率、漏诊率.结果:腹部CT检查,仅 6 例图像表现较为典型,表现为十二指肠水平段以上扩张;上消化道造影检查中,15 例患者可见典型"笔杆征".64 排螺旋CT诊断SMAS阳性 33 例、阴性 27 例、误诊 11 例、漏诊 18 例;上消化道造影诊断SMAS阳性 38 例、阴性 22 例、误诊 8 例、漏诊 10 例;联合检查诊断阳性 38 例、阴性 22 例、误诊 2 例、漏诊 4 例.联合检查诊断SMAS准确率、灵敏度、特异度、阳性预测值、阴性预测值均高于64 排螺旋CT、上消化道造影单一检查,误诊率、漏诊率均低于 64 排螺旋CT、上消化道造影单一检查,除特异度、阳性预测值、阴性预测值指标外,余指标对比差异有统计学意义(P＜0.05).同肠系膜上动脉造影术一致性良好(Kappa值=0.780).结论:联合上消化道钡餐造影和 64 排螺旋CT检查可以提高SMAS的诊断效果.
Abstract
Objective To explore the diagnostic value of upper gastrointestinal barium radiography and 64-slice spiral CT in superior mesenteric artery syndrome(SMAS).Methods Retrospective analysis of 60 suspected patients with SMAS admitted to Guigang City People's Hospital from January 2020 to January 2023,all patients were examined by 64-slice spiral CT and upper gastrointestinal barium meal radiography,and compared with the results of superior mesenteric artery angiography.The accuracy,sensitivity,specificity,misdiagnosis rate and missed diagnosis rate were calculated.Results Abdominal CT examination showed that only 6 cases showed typical images,showing dilatation above the horizontal segment of the duodenum with superior mesenteric artery stenosis,and 15 patients showed typical"pen sign"in upper gastrointestinal radiography.SMAS was diagnosed by 64-slice spiral CT in 33 cases,negative in 27 cases,misdiagnosis in 11 cases,missed diagnosis in 18 cases,upper gastrointestinal angiography in 38 cases,negative in 22 cases,misdiagnosis in 8 cases,missed diagnosis in 10 cases,combined examination in 38 cases,negative in 22 cases,misdiagnosis in 2 cases and missed diagnosis in 4 cases.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of combined examination in the diagnosis of SMAS were higher than those of 64-slice spiral CT and upper gastrointestinal radiography alone,but the misdiagnosis rate and missed diagnosis rate were lower than those of 64-row spiral CT and upper gastrointestinal radiography alone,except for specificity,positive predictive value and negative predictive value.There was significant difference in other indexes(P＜0.05).The consistency analysis was consistent with superior mesenteric arteriography(Kappa value=0.780).Conclusion The combination of upper gastrointestinal barium radiography and 64-slice spiral CT examination can improve the diagnostic effect of SMAS.
维普
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