切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 414 -418. doi: 10.3877/cma.j.issn.1674-3253.2019.06.013

所属专题： 文献；

临床研究

MR肠道成像及扫描前护理对克罗恩病肠道-泌尿道瘘的诊断价值
杨艳红1, 黄斯韵1, 林锦江1, 钟英奎1, 李雪华1,†()   
  1. 1. 510080　广州，中山大学附属第一医院放射诊断科
  • 收稿日期:2019-07-03 出版日期:2019-12-01
  • 通信作者: 李雪华

Value of MR enterography and pre-scanning nursing care for the characterization of enteric-urinary fistula in Crohn's disease

Yanhong Yang1, Siyun Huang1, Jinjiang Lin1, Yingkui Zhong1, Xuehhua Li1,†()   

  1. 1. Department of Radiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
  • Received:2019-07-03 Published:2019-12-01
  • Corresponding author: Xuehhua Li
  • About author:
    Corresponding Autor:Li Xuehhua, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

杨艳红, 黄斯韵, 林锦江, 钟英奎, 李雪华. MR肠道成像及扫描前护理对克罗恩病肠道-泌尿道瘘的诊断价值[J]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(06): 414-418.

Yanhong Yang, Siyun Huang, Jinjiang Lin, Yingkui Zhong, Xuehhua Li. Value of MR enterography and pre-scanning nursing care for the characterization of enteric-urinary fistula in Crohn's disease[J]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(06): 414-418.

目的

探讨MR肠道成像（MRE）及扫描前护理对克罗恩病（CD）肠道-泌尿道瘘的诊断价值。

方法

回顾性收集22例行手术治疗并有术前MRE扫描的CD肠道-泌尿道瘘患者临床资料。在MRE图上观察肠道-泌尿道瘘的位置和形态，并在电子病例系统上查阅患者的扫描前护理、扫描方案及手术记录。以术中所见的肠道-泌尿道瘘情况为金标准，分析MRE诊断肠道-泌尿道瘘的优劣势以及扫描前护理工作对其诊断的影响。

结果

22例患者中，MRE诊断为肠道-膀胱瘘者16例和肠道-输尿管瘘者5例，手术诊断为肠道-膀胱瘘者18例和肠道-输尿管瘘者15例。MRE诊断肠道-膀胱瘘的准确性较高（AUC=0.944；P=0.006），但诊断肠道-输尿管瘘的准确性较低（AUC=0.667；P=0.217）。未接受标准扫描前护理的患者MRE诊断肠道-泌尿道瘘的准确性（0/5）远低于接受标准扫描前护理者（12/17） （P=0.010）。

结论

MRE对肠道-膀胱瘘具有较高的诊断价值，但是难以准确诊断肠道-输尿管瘘；标准的MRE扫描前护理可改善图片质量而提高诊断准确率。

关键词: 克罗恩病, 瘘, MR肠道成像, 护理
Objective

To evaluate the diagnostic value of MR enterography (MRE) and pre-scanning nursing care for the characterization of enteric-urinary fistula in Crohn's disease(CD).

Methods

The preoperative MRE of 22 CD patients with enteric-urinary fistulas who underwent surgery were retrospectively analyzed. The location and morphology of the enteric-urinary fistulas were observed on MRE, and the pre-scan nursing care, scan protocol and surgical records were reviewed on the electronic medical record. Using the intraoperative findings of enteric-urinary fistulas as reference standard, the strengths and weaknesses of MRE and the influence of pre-scan nursing care for diagnosing enteric-urinary fistulas were respectively analyzed.

Results

Of 22 patients, 16 had enteric-bladder fistulas and 5 had enteric-ureteral fistulas on MRE, while 18 had enteric-bladder fistulas and 15 had enteric-ureteral fistulas in surgery. The accuracy of MRE was high for the detection of enteric-bladder fistulas (AUC=0.944, P=0.006) but low for enteric-ureteral fistulas (AUC=0.667, P=0.217). The accuracy of MRE in the patients who did not receive standard pre-scan nursing care (0/5) is significantly lower than those who received standard pre-scan nursing care (12/17) (P=0.010).

Conclusion

The diagnostic value of MRE is high for the enteric-bladder fistulas but low for the enteric-ureteral fistula. A standard pre-scan nursing care can improve diagnostic accuracy by enhancing the MR images quality.

Key words: Crohn's disease, Fistula, MR enterography, Nursing
图3 ROC曲线分析显示MRE诊断CD肠道-泌尿道瘘的准确性
[1]
Torres J, Mehandru S, Colombel JF, et al. Crohn's disease[J]. Lancet, 2017, 389(10080): 1741-1755.
[2]
Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies[J]. Lancet, 2018, 390(10114): 2769-2778.
[3]
朱维铭，谢颖. 克罗恩病并发内瘘的外科治疗原则[J/CD]. 中华普外科手术学杂志（电子版）, 2010, 04(4): 363-367.
[4]
Bruining DH, Zimmermann EM, Loftus EJ, et al. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease[J]. Radiology, 2018, 286(3): 776-799.
[5]
Park SH, Ye BD, Lee TY, et al. Computed tomography and magnetic resonance small bowel enterography: current status and future trends focusing on crohn's disease[J]. Gastroenterol Clin North Am, 2018, 47(3): 475-499.
[6]
Mojtahed A, Gee MS. Magnetic resonance enterography evaluation of Crohn disease activity and mucosal healing in young patients[J]. Pediatr Radiol, 2018, 48(9): 1273-1279.
[7]
江东，麦蕾，郭振宇, 等. 膀胱回肠瘘二例[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2016, 10(3): 211-213.
[8]
Ferguson GG, Lee EW, Hunt SR, et al. Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease[J]. J Am Coll Surg, 2008, 207(4): 569-572.
[9]
Bruining DH, Zimmermann EM, Loftus EJ, et al. Consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel crohn's disease[J]. Radiology, 2018, 286(3): 776-799.
[10]
Erden A, Unal S, Akkaya HE, et al. MR Enterography in Crohn's disease complicated with enteroenteric fistula[J]. Eur J Radiol, 2017, 94: 101-106.
[11]
Barat M, Hoeffel C, Bouquot M, et al. Preoperative evaluation of small bowel complications in Crohn's disease: comparison of diffusion-weighted and contrast-enhanced MR imaging[J]. Eur Radiol, 2019, 29(4): 2034-2044.
[12]
Sakala MD, Dillman JR, Ladino-Torres MF, et al. MR enterography of ileocolovesicular fistula in pediatric Crohn disease[J]. Pediatr Radiol, 2011, 41(5): 663-667.
[13]
Braithwaite KA, Alazraki AL. Use of the star sign to diagnose internal fistulas in pediatric patients with penetrating Crohn disease by MR enterography[J]. Pediatr Radiol, 2014, 44(8): 926-931.
[14]
Tolan DJ, Greenhalgh R, Zealley IA, et al. MR enterographic manifestations of small bowel Crohn disease[J]. Radiographics, 2010, 30(2): 367-384.
[15]
Iraha A, Koga E, Ohira T, et al. The clover sign of internal fistulas in Crohn disease[J]. Pol Arch Intern Med, 2019, 129(10): 707-708.
[1] 熊倩, 罗凤. 乳腺癌患者术后康复现状与对策的研究进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 372-374.
[2] 蔡柔妹, 曾洁梅, 黄伟丽, 谢文敏, 刘燕丹, 吴漫君, 蔡楚燕. 利用QC小组干预降低经烧伤创面股静脉置管导管相关性感染发生率的临床观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 399-404.
[3] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[4] 王亮, 符谨诚, 许薇, 李彦庆, 郭永波, 邹科见. 直肠成熟囊性畸胎瘤伴直肠阴道瘘一例并文献复习[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 117-118.
[5] 杨雪, 张伟, 尚培中, 宋创业, 尚丹丹, 张蔚. 胆囊十二指肠瘘结石经瘘口排出后自愈一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 707-708.
[6] 李雪, 刘文婷, 窦丽婷, 刘叶红. 联合护理在腹腔镜食管裂孔疝修补中的应用效果分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 750-754.
[7] 王红艳, 马艳丽, 郑洁灿. 手术室综合护理在腹股沟疝手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 755-758.
[8] 代格格, 杨丽, 胡媛媛, 周文婷. 手术室综合干预在老年腹股沟疝患者中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 759-763.
[9] 王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[10] 朱青青, 卫贞祺. 腹股沟疝患者围手术期自我能效管理探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 773-777.
[11] 戴玮, 江桂林, 车兆平, 张姣, 王星星, 赵海涛. 无缝手术护理在腹股沟疝腹腔镜手术围手术期的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 778-781.
[12] 李梅, 孔珊珊. Robocare护理模式联合高频胸壁振荡在腹腔镜腹壁切口疝修补术的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 619-624.
[13] 王秀, 王义国. 乌司奴单抗治疗克罗恩病肛周瘘管的有效性和安全性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 514-519.
[14] 姜里蛟, 张峰, 周玉萍. 多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 520-524.
[15] 王小娜, 谭微, 李悦, 姜文艳. 预测性护理对结直肠癌根治术患者围手术期生活质量、情绪及并发症的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 525-529.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号