以CT发现涡旋征作为肠扭转手术指征的临床研究

目的 评估CT检查单一出现涡旋征作为肠扭转手术指征的意义.方法 收集了从2006年1月至2011年4月期间临床拟诊肠扭转手术探查的39例患儿,术前均行CT检查.不告知临床资料,分别请3位高年资的CT诊断医师,3位普外科主治医师回顾性阅片.阅片的内容为是否有涡旋征、扭转的角度(扭转的角度以相差不超过180°为符合),记录结果,将肠扭转阅片结果与手术所见对照.计算诊断准确率、敏感率、特异率、Youden指数、阳性似然比、阴性似然比.结果 总准确率为81.7％,敏感率89.4％,特异率55.6％,Youden指数44.9％,阳性似然比2.18,阴性似然比0.21.6位医师阅片之间结果x2检验未见统计学差异.结论 单一出现涡旋征对肠扭转的诊断具有较高的敏感性；有肠梗阻症状,CT扫描出现涡旋征应该急诊手术；肠管或肠系膜的占位同时出现涡旋征应该急诊手术；旋转不良合并中肠扭转的涡旋征出现的位置可能会有变异；CT平扫不能准确反应肠扭转的角度.

The diagnostic value of the whirl sign in intestinal volvulus

Objective To evaluate the single whirl sign in CT scan as operational indication of intestinal volvulus.Methods The abdominal CT findings and clinical data of 39 cases with suspected intestinal volvulus were collected from Jan 2006 to Apr 2011.Three senior CT diagnosticians were in vited to read the CT scan respectively without any clinical information.The whirl sign and twisting angle size were measured.After comparing with operational findings,diagnostic accuracy,sensitivity,specificity,Youden index,positive likelihood ratio and negative likelihood ratio were calculated.Results The diagnostic accuracy was 81.7％,the sensitivity was 89.4％,the specificity was 55.6％,the Youden index was 44.9％,the positive likelihood ratio was 2.18 and the negative likelihood ratio was 0.21.Conclusions Single whirl sign has more sensitivity in diagnosis of intestinal volvulus.Clinical signs of intestinal obstruction with whirl sign in CT scan are indications of emergency operation,and tumors in intestinal canal or mesentery with whirl sign also need emergency operation.The position of whirl sign may be distorted in patients with the intestinal malrotation.However,CT scan cannot show the twist angle of intestinal volvulus.