CT仿真内镜对原发性小肠恶性肿瘤的诊断价值

周涛　刘振翠

[摘要] 目的 探讨CT仿真内镜（CTVE）对原发性小肠恶性肿瘤的诊断价值。 方法 选择河北省唐山市中医医院2010年1月～2014年10月收住院的疑似小肠肿瘤并行CTVE检查的患者53例。对CTVE检查结果与手术或内镜活检病理诊断进行一致性检验分析，观察CTVE诊断原发性小肠恶性肿瘤的准确度、灵敏度、特异度。 结果 手术或内镜活检病理诊断结果显示，53例患者中，原发性小肠恶性肿瘤29例，良性肿瘤24例。CTVE检查结果：小肠原发性恶性肿瘤30例，良性肿瘤23例。两种方法诊断原发性小肠恶性肿瘤的一致性较好（Kappa值=0.75），CTVE诊断原发性小肠恶性肿瘤的准确度、灵敏度、特异度分别为90.6%、93.1%、87.5%。 结论 CTVE技术操作简单、安全、无创伤性，易被患者接受。CTVE诊断原发性小肠恶性肿瘤的敏感度、特异度、准确度较高，具有较好的临床应用价值。

[关键词] 原发性小肠恶性肿瘤；小肠良性肿瘤；CT仿真内镜；病理检查

[中图分类号] R735.34 [文献标识码] A [文章编号] 1673-7210（2015）02（b）-0130-03

[Abstract] Objective To explore the diagnostic value of CT virtual endoscopy（CTVE） for patients with primary malignancy of small intestines. Methods 53 cases of elder patients in Hospital of Traditional Chinese Medicine in Tangshan City suspected small intestinal tumor were selected as subjects from January 2010 to October 2014. All patients were underwent CTVE examination. The consistency between CTVE and operation or endoscopic biopsy pathological diagnosis was analyzed. The accuracy， sensitivity， specificity of CTVE were observed in diagnosis of primary malignant tumors of small intestine. Results The results of operation or endoscopic biopsy pathological examination showed that， among 53 patients， 29 cases were primary malignant tumors of the small intestine， 24 cases were benign tumor of all the cases. The results of CTVE showed that， 30 cases were primary malignant tumors of the small intestine， 23 cases were benign tumor of all the cases. Consistency test result showed that the two methods had good consistency （Kappa=0.75）. The accuracy， sensitivity， specificity of CTVE were 90.6%， 93.1%， 87.5%. Conclusion CTVE technology has the advantages of simple operation， safe， noninvasive， easy to be accepted by patients. In the diagnosis of primary malignant tumors of the small intestine， the sensitivity， specificity and accuracy are higher， it has a good clinical application value.

[Key words] Primary malignant tumors of small intestine； Intestinal benign tumor； CT virtual endoscopy； Pathology

原发性小肠恶性肿瘤发病率较低，占胃肠道肿瘤的1%～3%，因其早期临床症状和体征缺乏特异性，临床早期诊断十分困难，误诊率较高。传统的内镜检查范围有限，胃十二指肠镜只能到达十二指肠与空肠交界处，结肠镜则只能达回肠未端。小肠镜检查由于花费时间长、患者极度不适，易引起出血、穿孔等并发症，且假阴性率较高，临床应用受限。近年来随着螺旋CT的发展，计算机软件的开发，CT仿真内镜（CTVE）对小肠疾病的诊断备受关注。CTVE作为一种新的影像技术，具有良好的软组织对比度及三维成像能力，能够观察小肠黏膜及肠管周围的改变，提高了对小肠肿瘤早期确诊率[1]，操作相对简单，患者痛苦较小。……