胃癌术后 吻合口瘘 的影像学表现培训课件.ppt

* . . * . . . 摘要目的评估常规CT 检测胃术后吻合口瘘的诊断效能，并分析术后恢复期与CT 表现之间的关系。方法本研究的受试人群包括胃术后即刻行CT 和X 线透视检查的179 例病人。2 名阅片者回顾性地根据提前设定的CT 表现，采用五级评分法评估吻合口瘘的可能性，并对CT 表现进行评价。病人分为3 组：Ⅰ组，X 线透视可以看到吻合口瘘；Ⅱ组，CT提示可能存在吻合口瘘而X 线透视未发现瘘；Ⅲ组，无吻合口瘘。分析术后恢复期与不同组间的关系。结果2 名阅片者检测CT 上吻合口瘘的一致性为中度（κ=0.482），ROC 曲线下面积分别为0.886 和0.668。共同有统计学意义的吻合口瘘CT 表现包括壁不连续、大量气液潴留以及吻合口处壁增厚（P0.05），其中吻合口处壁不连续以及大量气液潴留与吻合口瘘有独立相关性（P0.05）。术后恢复期包括住院治疗以及术后禁食期， 其中Ⅰ组的术后恢复期长于Ⅱ组和Ⅲ组（P0.05），而Ⅱ组的术后恢复期长于Ⅲ组（P0.05）。结论胃术后常规CT 的特异性表现对评估吻合口瘘以及预测术后恢复期长短有重要意义 原文载于Eur Radiol，2015，25（7）：1958－1966． * . . 女性，78岁，clipping with a definite leak after subtotal mastectomy on CT and fluoroscopic examination (Group I). a–c Transverse plane CT images which were performed 6 days after subtotal mastectomy with Billroth-I anastomosis show wall discontinuity (white arrows) and large air-fluid collection at the anastomosis site and sub-hepatic area (white arrowheads). Wall thickening at the anastomosis site is also noted (black arrowheads). Both radiologists diagnosed this as a definite anastomotic leak. d Follow-up fluoroscopic examination which was performed 2 days after CT examination shows extraluminal contrast leak (black arrows) at the anastomosis site. The large air-fluid collection at the anastomosis site is also noted (back arrowheads). The recovery period was 23 days of postoperative fasting period and 39 days of hospitalisation period * . Fig. 4 A 64-year-old man with a probable leak on CT after total gastrectomy but no anastomotic leak on fluoroscopic examination (Group II). a and b Transverse plane CT images which were performed 7 days after total gastrectomy show wall discontinuity (white arrows) and large air-fluid collection at the anastomosis site and left sub-phrenic area (white arrowheads). Wall thickening at the anastomosis site is also noted (black arrowheads). c Multiplanar reformation with coronal plane CT image shows loculated large air-fluid collection at the left sub-phrenic area (white arrowheads). Both radiologists diagnosed this as a pr