Yoshida Naohiro, Sadakari Yoshihiko, Nakane Hiroyuki, Yoshitomi Munehiro, Tamehiro Kazuhito, Hirokata Gentaro, Aoyagi Takeshi, Ogata Toshiro, Taniguchi Masahiko
Department of Surgery, St. Mary's Hospital.
Department of Intensive Care, St. Mary's Hospital.
Kurume Med J. 2024 Dec 10;70(3.4):121-130. doi: 10.2739/kurumemedj.MS7034005. Epub 2024 Aug 5.
Very few studies have examined the association between contrast-enhanced computed tomography (CT) findings observed in portal venous gas (PVG) and pneumatosis intestinalis (PI) and the underlying diseases in these conditions.
In this study, we analyzed this association and report the findings for predicting mortality.
Overall, 50 patients diagnosed with PVG or PI, observed on contrast-enhanced CT, underwent treatment at our hospital. Based on the underlying disease, we divided the patients into three groups, those with ischemic disease, infectious disease, or gastrointestinal dilatation. Furthermore, cases that underwent surgical treatment or needed surgery but were inoperable were assigned to the high risk group (n=16) and patients who received conservative treatment were assigned to the low risk group (n=34). We reviewed the patients' medical charts, laboratory data, and CT images retrospectively, and analyzed the relationship between CT findings, underlying disease, and association with the high risk or low risk group in each case.
Poor enhancement of the intestinal wall, mesenteric fat stranding, extrahepatic PVG, advanced age, and renal disease were significantly associated with ischemic disease (p=0.02, p=0.02, p=0.005, p=0.008 and p=0.049, respectively). PI alone was strongly associated with gastrointestinal dilatation (p=0.009). Patients in the low risk group had more favorable outcomes with conservative treatment. In multivariate analysis, extrahepatic PVG was the only factor associated with the high risk group (p=0.002).
Extrahepatic PVG associated with ischemic disease was the strongest predictive factor of mortality. Other CT findings, though useful in diagnosing the underlying disease, were not significant predictive factors.
很少有研究探讨门静脉气体（PVG）和肠壁积气（PI）的对比增强计算机断层扫描（CT）表现与这些情况下的基础疾病之间的关联。
在本研究中，我们分析了这种关联并报告了预测死亡率的结果。
总体而言，50例经对比增强CT观察诊断为PVG或PI的患者在我院接受治疗。根据基础疾病，我们将患者分为三组，即患有缺血性疾病、感染性疾病或胃肠道扩张的患者。此外，接受手术治疗或需要手术但无法手术的病例被归入高风险组（n = 16），接受保守治疗的患者被归入低风险组（n = 34）。我们回顾性地查阅了患者的病历、实验室数据和CT图像，并分析了CT表现、基础疾病以及每种情况下与高风险或低风险组的关联。
肠壁强化不佳、肠系膜脂肪条索状影、肝外PVG、高龄和肾脏疾病与缺血性疾病显著相关（分别为p = 0.02、p = 0.02、p = 0.005、p = 0.008和p = 0.049）。单独的PI与胃肠道扩张密切相关（p = 0.009）。低风险组的患者通过保守治疗有更良好的预后。在多变量分析中,肝外PVG是与高风险组相关的唯一因素（p = 0.002）。
与缺血性疾病相关的肝外PVG是死亡率的最强预测因素。其他CT表现虽然有助于诊断基础疾病，但不是显著的预测因素。
