摘要目的 探讨多层螺旋CT小肠重建技术在Crohn病术后患者回-结肠吻合口复发评价中的应用价值.方法 31例曾行小肠及部分结肠切除并回-结肠吻合、经手术病理诊断的Crohn病患者,口服2.5%甘露醇后应用64层螺旋CT行腹盆扫描,包括平扫、动脉期和门脉期扫描.利用门脉期图像,结合多平面重建技术,观察吻合口CT异常征象.以结肠镜、手术病理及临床活动指数评分为依据判断吻合口复发和正常,将患者分为活动组和静息组,分析CT征象对于判断复发的敏感性、特异性、准确性、阳性预测值和阴性预测值.结果 活动组和静息组患者分别有26例和5例.活动组有11例(42%)患者肠系膜淋巴结短径＞1 cm,8例(31%)吻合口周围瘘,静息组患者均无上述征象,但两组间差异无统计学意义(P＞0.05).活动组有16例(62%)吻合口壁厚＞6 mm、19例(73%)吻合口明显强化、14例(54%)强化后呈分层状及20例(77%)吻合口周围索条,静息组患者均无上述征象,两组间差异有统计学意义(P均＜0.05).如果肠系膜淋巴结短径＞1 cm、吻合口周围瘘、吻合口壁厚＞6 mm、吻合口明显强化、强化后呈分层状、吻合口周围索条6种CT征象中出现2种诊断吻合口复发,其敏感性为88%,特异性100%,阳性预测值100%,阴性预测值63%,准确性90%.CT诊断吻合口狭窄的准确性仅53%.结论 Crohn病术后患者回-结肠吻合口复发有较客观和特异性的CT表现,CT小肠重建技术可用于判断吻合口复发.

abstractsObjective To determine the utility of computed tomographic (CT) enteroclysis for characterization of the status of the anastomotic site in patients with Crohn's disease (CD) who have previously undergone ileocolic resection. Methods Totally 31 CD patients who had previously undergone ileocolic resection were enrolled in the study. After having been orally administered with isosmotic mannitol, the patients received CT scanning including plain scan, arterial phase scan, and portal venous phase scan. The abnormal CT findings were analyzed based on portal venous phase images. CT enteroclysis findings in 31 patients were evaluated by two radiologists in consensus. Endoscopic findings, histopathologic findings, and/or the Crohn's disease activity index (CDAI) were used as the reference criteria. Associations between CT enteroclysis findings and anastomotic site status were assessed. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT enteroclysis for the diagnosis of normal anastomosis versus anastomotic recurrence were estimated. Results Twenty-six cases and 5 cases were diagnosed as disease recurrence and normal anastomosis, respectively. In the disease recurrence group, 11 patients (42%) had lymphadenopathy (diameter＞ 1 cm) and 8 patients (31%) had peri-anastomotic fistulas, which were absent in normal anastomosis group, but the difference was not significant Anastomotic wall thickening more than 6 mm, marked mucosal enhancement, stratification, and peri-anastomotic stranding were found in 16 (62%), 19 (73%), 14 (54%), and 20 (77%) cases, respectively, in disease recurrence group, which were absent in normal anastomosis group ( all P ＜ 0.05 ). When the diagnosis of anastomotic recurrence was based on more than two of the following six variables, including lymphadenopathy, peri-anastomotic fistulas, anastomotic wall thickening more than 6 mm, marked mucosal enhancement, stratification, and peri-anastomotic stranding, its sensitivity, specificity, postive predictive value, negative predictive value, and accuracy yielded 88%, 100%, 100%, 63%, and 90%, respectively. The diagnostic accuracy of anostomotic stenosis with CT was only 53%. Conclusion CT enteroclysis yields objective and relatively specific morphologic criteria that help differentiate between recurrent disease and normal at the anastomotic site after ileocolic resection for CD.