计算机断层扫描在检测需要手术干预的钝性肠和肠系膜损伤中的有效性：系统文献回顾。
Effectiveness of computed tomography scanning to detect blunt bowel and mesenteric injuries requiring surgical intervention: A systematic literature review.
机构信息
Department of Surgical Education, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH, USA.
Trauma/Neuroscience Research Department, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave, Youngstown, OH, USA.
出版信息
Am J Surg. 2019 Jul;218(1):201-210. doi: 10.1016/j.amjsurg.2018.08.018. Epub 2018 Aug 30.
BACKGROUND
Computed tomography (CT) diagnostic accuracy for blunt bowel and mesenteric injuries (BBMI) is controversial.
DATA SOURCES
A literature review to compute aggregate CT performance and individual CT sign sensitivity, specificity, and positive predictive value (PPV) for operative BBMI.
CONCLUSIONS
Sensitivity, specificity, and PPV were: overall CT performance 85.3%, 96.1%, 51.4%; abnormal wall enhancement 30.1%, 95.7%, 64.0%; bowel wall discontinuity 22.3%, 99.0%, 87.9%; bowel wall hematoma 22.5%, 100%, 19.5%; bowel wall thickening 35.2%, 96.5%, 32.1%; free air 32.0%, 98.7%, 57.1%; free fluid 65.6%, 85.0%, 25.5%; mesenteric air 27.6%, 99.1%, 85.3%; mesenteric extravasation 22.9%, 99.6%, 73.9%; mesenteric hematoma/fluid 33.9%, 98.7%, 52.8%; mesenteric stranding/streaking 34.3%, 91.8%, 31.6%; mesenteric vessel beading 32.1%, 97.2%, 60.4%; mesenteric vessel termination 31.6%, 97.2%, 63.5%; oral contrast extravasation 10.0%, 100%, 100%; retroperitoneal air 9.4%, 94.9%, 55.6%; and retroperitoneal fluid 44.2%, 49.4%, 38.5%. Sensitivity, specificity, and PPV vary substantially among known signs. Other clinical factors are necessary for comprehensive BBMI identification.
背景
计算机断层扫描（CT）对钝性肠和肠系膜损伤（BBMI）的诊断准确性存在争议。
资料来源
对手术 BBMI 的 CT 性能综合指标和个体 CT 征象敏感性、特异性和阳性预测值（PPV）进行文献回顾。
结论
敏感性、特异性和 PPV 分别为：整体 CT 性能 85.3%、96.1%、51.4%；异常肠壁增强 30.1%、95.7%、64.0%；肠壁连续性中断 22.3%、99.0%、87.9%；肠壁血肿 22.5%、100%、19.5%；肠壁增厚 35.2%、96.5%、32.1%；游离气 32.0%、98.7%、57.1%；游离液 65.6%、85.0%、25.5%；肠系膜积气 27.6%、99.1%、85.3%；肠系膜外渗 22.9%、99.6%、73.9%；肠系膜血肿/积液 33.9%、98.7%、52.8%；肠系膜绞缠/条纹征 34.3%、91.8%、31.6%；肠系膜血管串珠征 32.1%、97.2%、60.4%；肠系膜血管终末征 31.6%、97.2%、63.5%；口服对比剂外渗 10.0%、100%、100%；腹膜后积气 9.4%、94.9%、55.6%；腹膜后积液 44.2%、49.4%、38.5%。各已知征象的敏感性、特异性和 PPV 差异很大。其他临床因素对全面识别 BBMI 是必要的。
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