刘彩云，李绍东

（1.徐州医学院影像学院，江苏 徐州 221000；2.徐州医学院附属第三医院影像科，江苏 徐州 221000；3.徐州医学院附属医院影像科，江苏 徐州 221000）



食管穿孔及其纵隔、胸腔污染程度的综合影像诊断

刘彩云1，2，李绍东3

（1.徐州医学院影像学院，江苏 徐州 221000；2.徐州医学院附属第三医院影像科，江苏 徐州 221000；3.徐州医学院附属医院影像科，江苏 徐州 221000）

目的：总结延误诊断食管穿孔患者的口服泛影葡胺上消化道X线造影（简称X线造影）、MSCT征象，探讨X线造影、MSCT对延误诊断食管穿孔的诊断价值。方法：回顾性分析经胃镜证实的40例食管穿孔患者（共43个破口）的临床和影像资料，所有患者均行颈胸部MSCT连续扫描和X线造影。对MSCT所显示的积气、脓肿、胸腔积液进行评分，采用Spearman法分析MSCT各征象评分与食管破口直径间的相关性。利用Kappa一致性检验分析MSCT和X线造影诊断食管破口位置、食管穿孔的一致性。结果：积气、脓肿、胸腔积液的评分分别为1（0～7）、1（0～5）、1（0～4）分，食管破口的中位直径6.5 mm（2～40 mm），以上MSCT各征象评分与食管破口直径间均有相关性（r=0.50、0.62、0.59，均P＜0.05）。MSCT、X线造影诊断食管破口分别为38例（38个）、38例（41个），2种检查方法诊断食管破口位置的一致性较好（K=0.54、0.66，均P＜0.05）。结论：MSCT可较全面评价延误诊断食管穿孔及纵隔、胸腔污染的严重程度，为临床医师选择个体化的治疗方式提供帮助。

食管穿孔；体层摄影术，X线计算机

［Abstract］Objective：The purpose of our study was to summarize the MSCT imaging of delayed diagnosis of esophageal perforation，to score the degree of contamination within the mediastinum and pleural space，and to discuss the diagnostic value of MSCT in the diagnosis of esophageal perforation.Methods：Forty patients diagnosed esophageal perforation were enrolled（a total of 43 rips）and their clinical and imaging findings were retrospectively analyzed.MSCT scan of the chest and fluoroscopic esophagography were performed in all cases.The imaging was assessed.MSCT abnormalities，including free gas，abscess，pleural effusion，were assessed with a semi-quantitative score system.The gastroscopy examination results at the same period with MSCT were collected.The relationships between the MSCT scores and esophageal tear diameters were analyzed with Spearman correlation analysis.Kappa analysis was performed to assess the agreement of the imaging of MSCT and fluoroscopic esophagography，which diagnosed the esophageal perforation location and esophageal perforation.Results：The scores of free gas，abscess and pleural effusion，were 1（0～7），1（0～5），1（0～4），respectively.The median diameter of the esophageal perforation was 6.5 mm （2 mm～40 mm）.There was positive relationship between the above scores and esophageal perforation diameter（r=0.50、0.62、0.59，P＜0.05，respectively）.Good agreement was identified with Kappa values of 0.54 and 0.66，respectively.Conclusion：MSCT could evaluate the severity of delayed diagnosis of esophageal perforation and mediastinal contamination，which is key factor in determining further conservative or surgical management.

［Key words］Esophageal perforation；Tomography；X-ray computed

食管穿孔是临床上少见的危重急症，病情进展快，误诊率高，尤其自发性食管破裂的误诊率达74.3%～84.6%，24 h内治疗死亡率达36%，延误诊断（一般把临床症状开始至24 h后未经发现的食管穿孔称为延误诊断）死亡率高达60%，甚至100%［1］。……