Jha Ashwini Kumar, Tang Wen Hao, Bai Zhi Bin, Xiao Jia Quan
Department of General Surgery, JMCTH, Janakpurdham, Dhanusha, Nepal.
Department of General Surgery, ZhongDa Hospital Affiliated To SouthEast University, Nanjing, China.
JNMA J Nepal Med Assoc. 2014 Jan-Mar;52(193):735-44.
To perform a meta-analysis to review the sensitivity and specificity of computed tomography and different known computed yomography signs for the diagnosis of strangulation in patients with acute small bowel obstruction.
A comprehensive Pubmed search was performed for all reports that evaluated the use of CT and discussed different CT criteria for the diagnosis of acute SBO. Articles published in English language from January 1978 to June 2008 were included. Review articles, case reports, pictorial essays and articles without original data were excluded. The bivariate random effect model was used to obtain pooled sensitivity and pooled specificity. Summary receiver operating curve was calculated using Meta-Disc. Software Openbugs 3.0.3 was used to summarize the data.
A total of 12 studies fulfilled the inclusion criteria. The pooled sensitivity and specificity of CT in the diagnosis of strangulation was 0.720 (95% CI 0.674 to 0.763) and 0.866 (95% CI 0.837 to 0.892) respectively. Among different CT signs, mesenteric edema had highest Pooled sensitivity of 0. 741 and lack of bowel wall enhancement had highest pooled specificity of 0.991.
This review demonstrates that CT is highly sensitive as well as specific in the preoperative diagnosis of strangulation SBO which are in accordance with the published studies. Our analysis also shows that "presence of mesenteric fluid" is most sensitive, and "lack of bowel wall enhancement" is most specific CT sign of strangulation, and also justifies need of large scale prospective studies to validate the results obtained as well as to determine a clinical protocol.
进行一项荟萃分析，以回顾计算机断层扫描（CT）及不同已知CT征象对急性小肠梗阻患者绞窄性肠梗阻诊断的敏感性和特异性。
对所有评估CT使用情况并讨论急性小肠梗阻诊断不同CT标准的报告进行全面的PubMed检索。纳入1978年1月至2008年6月发表的英文文章。排除综述文章、病例报告、图片文章及无原始数据的文章。采用双变量随机效应模型获得合并敏感性和合并特异性。使用Meta-Disc计算总结性受试者工作曲线。使用软件Openbugs 3.0.3汇总数据。
共有12项研究符合纳入标准。CT诊断绞窄性肠梗阻的合并敏感性和特异性分别为0.720（95%可信区间0.674至0.763）和0.866（95%可信区间0.837至0.892）。在不同CT征象中，肠系膜水肿的合并敏感性最高，为0.741，肠壁强化缺失的合并特异性最高，为0.991。
本综述表明，CT在绞窄性小肠梗阻的术前诊断中具有高敏感性和特异性，这与已发表的研究一致。我们的分析还表明，“肠系膜积液”是绞窄最敏感的CT征象，“肠壁强化缺失”是绞窄最特异的CT征象，同时也证明需要进行大规模前瞻性研究以验证所得结果并确定临床方案。
