Ponrartana Skorn, Coakley Fergus V, Yeh Benjamin M, Breiman Richard S, Qayyum Aliya, Joe Bonnie N, Poder Liina, Lu Ying, Gibbs Verna C, Roberts John P
Department of Radiology, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
Ann Surg. 2008 Jan;247(1):8-12. doi: 10.1097/SLA.0b013e31812eeca5.
To determine the accuracy of plain abdominal radiographs in the detection of retained surgical needles of varying size in the peritoneal cavity.
Accidental retention of surgical foreign bodies in the peritoneal cavity is estimated to occur once in every 1000 to 1500 abdominal operations and early prevention and identification of retained foreign bodies is increasingly important because of mounting public awareness. Most of the existing literature on the imaging detection of surgical foreign bodies has focused on retained sponges, even though retained needles may account for up to 50% of such objects and the true accuracy of plain abdominal radiographs in the detection of retained needles is not well established.
Eight plain radiographs were obtained of a 41 kg pig cadaver after placement of a total of 39 surgical needles of varying size (4-77 mm in length) in a randomized selection of the 9 segments of the peritoneal cavity. Five radiologists independently reviewed the radiographs and indicated the location of all suspected retained needles. Analyses were performed using the known site and size of placed needles as the standard of reference.
In total for all readers, 195 needles were detectable in 360 abdominal segments. The overall mean accuracy, sensitivity, and specificity for plain radiographs in the detection of retained surgical needles were 74% (267 of 360), 69% (135 of 195), and 80% (132 of 165), respectively. Sensitivity for needles 25 mm or more in length was significantly (P < 0.0001) higher than that for needles of 11 to 24 mm or 10 mm or less, with respective values of 99% (69 of 70), 84% (46 of 55), and 29% (20 of 70). Readers demonstrated moderate interobserver agreement, with a multireader kappa value of 0.60.
Abdominal radiographs have high sensitivity and interobserver agreement in the detection of retained surgical needles over 10 mm in length, but smaller needles are detected with significantly lower sensitivity and the utility of plain abdominal radiographs in this setting is more debatable.
确定腹部平片检测腹腔内不同尺寸手术缝针的准确性。
据估计，腹腔内意外遗留手术异物的情况在每1000至1500例腹部手术中会发生一次，随着公众意识的提高，早期预防和识别遗留异物变得越来越重要。现有的关于手术异物影像学检测的大多数文献都集中在遗留海绵上，尽管遗留缝针可能占此类异物的50%，但腹部平片检测遗留缝针的真正准确性尚未明确确立。
在一头41千克的猪尸体的腹膜腔9个节段中随机放置总共39根不同尺寸（长度为4 - 77毫米）的手术缝针后，获取8张腹部平片。5位放射科医生独立阅片，并指出所有疑似遗留缝针的位置。以已知放置缝针的部位和尺寸作为参考标准进行分析。
所有阅片者总共在360个腹部节段中检测到195根缝针。腹部平片检测遗留手术缝针的总体平均准确性、敏感性和特异性分别为74%（360个节段中的267个）、69%（195根中的135根）和80%（165根中的132根）。长度为25毫米或更长的缝针的敏感性显著高于长度为11至24毫米或10毫米或更短的缝针（P < 0.0001），其敏感性分别为99%（70根中的69根）、84%（55根中的46根）和29%（70根中的20根）。阅片者之间表现出中等程度的观察者间一致性，多阅片者kappa值为0.60。
腹部平片在检测长度超过10毫米的遗留手术缝针方面具有较高的敏感性和观察者间一致性，但检测较小的缝针时敏感性显著较低，在此情况下腹部平片的实用性更具争议性。
