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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (03) : 232 -236. doi: 10.3877/cma.j.issn.1672-6448.2019.03.014

所属专题: 文献

腹部超声影像学

经腹肠道超声在克罗恩病术后复发及合并症中的诊断价值
庄楠1, 李文波1, 朱庆莉1,(), 王妙倩1, 杨红2, 刘炜3, 周炜洵4   
  1. 1. 100730 中国医学科学院 北京协和医学院 北京协和医院超声科
    2. 100730 中国医学科学院 北京协和医学院 北京协和医院消化内科
    3. 100730 中国医学科学院 北京协和医学院 北京协和医院放射科
    4. 100730 中国医学科学院 北京协和医学院 北京协和医院病理科
  • 收稿日期:2018-09-27 出版日期:2019-03-01
  • 通信作者: 朱庆莉
  • 基金资助:
    中国医学科学院医学与健康科技创新工程项目(2017-I2M-1-006)

Diagnostic value of trans-abdominal intestinal ultrasound in postoperative recurrence and complications of Crohn′s disease

Nan Zhuang1, Wenbo Li1, Qingli Zhu1,(), Miaoqian Wang1, Hong Yang2, Wei Liu3, Weixun Zhou4   

  1. 1. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
    2. Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
    3. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
    4. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2018-09-27 Published:2019-03-01
  • Corresponding author: Qingli Zhu
  • About author:
    Corresponding author: Zhu Qingli, Email:
引用本文:

庄楠, 李文波, 朱庆莉, 王妙倩, 杨红, 刘炜, 周炜洵. 经腹肠道超声在克罗恩病术后复发及合并症中的诊断价值[J]. 中华医学超声杂志(电子版), 2019, 16(03): 232-236.

Nan Zhuang, Wenbo Li, Qingli Zhu, Miaoqian Wang, Hong Yang, Wei Liu, Weixun Zhou. Diagnostic value of trans-abdominal intestinal ultrasound in postoperative recurrence and complications of Crohn′s disease[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(03): 232-236.

目的

评估经腹肠道超声在检测克罗恩病(CD)术后吻合口复发方面的准确性。

方法

选取2015年5月至2018年1月北京协和医院就诊的CD术后患者32例,行肠道超声检查,以肠镜和(或)手术病理和(或)临床评分为"金标准",将患者分为复发组与缓解组。采用χ2检验,评价超声征象在复发组与缓解组中的差异,采用四格表计算肠道超声诊断CD术后吻合口复发的敏感度、特异度、准确性阳性预测值和阴性预测值。

结果

复发组患者30例,缓解组患者2例。以吻合口处肠壁厚度>0.3 cm及肠壁结构不清为诊断标准时,超声对CD复发的敏感度、特异度、阳性预测值和阴性预测值分别为97%、100%、100%、67%。确诊29例,超声诊断吻合口及其他部位肠瘘共15例(15/32)的准确性为100%,诊断吻合口狭窄共8例(8/32),准确性为100%。

结论

肠道超声在CD术后吻合口临床复发有特征性表现,在CD术后复发的监测和随访上有应用价值。

Objective

To evaluate the accuracy of trans-abdominal ultrasound in detecting postoperative recurrence in crohn′s disease.

Methods

A total of 32 patients in PUMCH who received curative resection for the treatment of CD were enrolled. All the patients underwent trans-abdominal ultrasound for the detection of postoperative recurrence of CD. Based on the enteroscopy, histopathology and the Crohn′s Disease Active Index, we divided all patients into the active phase group and the quiescent phase group. To evaluate the diagnostic performance of transabdominal ultrasound in detecting postoperative recurrence of CD, the sensitivity, specificity, and positive and negative predictive value were measured.

Results

Among the 32 patients, there were 30 patients in the active phase group, and 2 in the quiescent group. For two ultrasonic signs, the bowel wall thickness>3 mm, the loss of bowel wall stratification, the sensitivity, specificity, and positive and negative predictive value were 97%, 100%, 100%, 67%, respectively. A total of 29 cases were accurately diagnosed by ultrasound, and the overall accuracy of ultrasound in detecting fistula (on the anastomosis and other site) and anastomotic stenosis were 100%, 100%, respectively.

Conclusions

Due to the specific imaging features of clinical anastomotic recurrence, the trans-abdominal ultrasound plays an important role in monitoring the postoperative recurrence of CD.

图1 患者,女性,37岁,回盲部、升结肠切除+回结肠吻合术后5年,吻合口处克罗恩病复发,超声与肠镜对照图像。图a肠道超声示吻合口处肠壁增厚、结构不清,肠壁内见溃疡(条形强回声,箭头所示);图b肠镜示吻合口处黏膜充血水肿,证实吻合口溃疡、表面覆白苔。超声及肠镜均诊断吻合口处溃疡形成,吻合口复发
表1 32例患者的超声异常征象在两组中的分布[例(%)]
图2 患者,女性,26岁,结肠次全切除+回肠-乙状结肠吻合术后10年,吻合口外肠瘘,超声与CTE对照图像。图a肠道超声示吻合口近端小肠(I)后壁见一条形低回声(箭头所示)与乙状结肠(S)前壁相通;图b CTE示乙状结肠肠壁增厚、强化,与小肠分解不清(箭头所示)。超声及CTE均提示吻合口近端乙状结肠-小肠瘘形成
表2 超声异常征象对CD复发的诊断价值(%)
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