Đặc điểm hình ảnh và giá trị của cắt lớp vi tính đa dãy trong chẩn đoán tắc ruột=Imaging features and values of multi-slice computed tomography in diagnosing bowel obstruction

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Tác giả: Dương Hương Ly Bùi, Hoa Huệ Nguyễn, Đức Trung Vương

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.279-285

Bộ sưu tập: Báo, Tạp chí

ID: 478159

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Mô tả đặc điểm hình ảnh và đánh giá giá trị của cắt lớp vi tính (CLVT) đa dãy trong chẩn đoán tắc ruột. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên 60 bệnh nhân được chụp CLVT ổ bụng đa dãy có tiêm thuốc cản quang trước phẫu thuật, được phẫu thuật ổ bụng với chẩn đoán sau mổ là tắc ruột cơ giới tại bệnh viện Ung Bướu Hà Nội từ tháng 9/2022 đến tháng 9/2023. Các đặc điểm hình ảnh trên CLVT được mô tả, đối chiếu với kết quả phẫu thuật nhằm xác định độ nhạy (Se), độ đặc hiệu (Sp), giá trị dự đoán dương tính (PPV), giá trị dự đoán âm tính (NPV). Kết quả: Dấu hiệu quai ruột non giãn, mức nước – hơi là các dấu hiệu hay gặp lần lượt ở 60/60 (100%) và 56/60 (93,3%) bệnh nhân. Độ đặc hiệu trong chẩn đoán vị trí tắc ruột (ruột non – ruột già) đạt 96,7%. Độ đặc hiệu trong chẩn đoán các nguyên nhân do u, dây ch ằng và dính lần lượt là 100%, 89,1%, 87,2%. Chẩn đoán biến chứng thiếu máu thành ruột, các dấu hiệu khí trong phúc mạc, khí trong thành ruột, mạc treo kém/không ngấm thuốc đều đạt độ đặc hiệu 100%. Kết luận: CLVT đa dãy có tiêm thuốc cản quang có giá trị cao trong chẩn đoán tắc ruột cũng như gợi ý một số nguyên nhân và dự báo biến chứng thiếu máu thành ruột.To describe the imaging features and to assess the value of multi-slice computed tomography (MSCT) in diagnosing bowel obstruction. Materials and Methods: A cross-sectional descriptive study was conducted on 60 patients who underwent contrast-enhanced MSCT before surgery and were diagnosed post-operatively with mechanical bowel obstruction at Hanoi Oncology Hospital from September 2022 to September 2023. Imaging features on MSCT were described and compared with surgical findings to determine sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). Results: The most common imaging signs were dilated small bowel loops and air-fluid levels, appeared in 60 (100%) and 56 (93.3%) patients, respectively. The specificity of identifying the obstruction site (small bowel vs. large bowel) was 96.7%. Specificities of diagnosing obstruction causes including tumor, ligament, and adhesion were 100%, 89.1%, and 87.2%, respectively. The specificity of diagnosing ischemic bowel wall, as well as signs of free intraperitoneal air, pneumatosis intestinalis, and poorly/non-enhancing mesentery, was all 100%. Conclusion: Contrast-enhanced multi-slice CT is highly valuable in diagnosing bowel obstruction, identifying potential causes, and predicting complications such as ischemic bowel wall.

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