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介肠底部宽度:腹壁直径与婴儿的肠道旋转异常相关
Katherine Bergus1, Destiny Duvall2, Brittany Albers3
1Nationwide Children's Hospital, Center for Surgical Outcomes Research and Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH 43205, USA.
一个新的光镜测量,介质底部宽度与腹壁直径比 (MBW:AWD),准确地识别了婴儿的肠道旋转异常. 最佳比率为0.55,可以帮助指导管理决策,以解决旋转不良的问题.
科学领域:
- 儿科手术 儿科手术
- 诊断成像 诊断成像 诊断成像
- 胃肠病学 胃肠病学
背景情况:
- 有症状的肠道转变不良需要迅速进行手术 (拉德手术).
- 偶然或不确定的恶性旋转发现的管理有所不同,包括观察或手术.
- 双关节 (DJJ) 和关节 (ICJ) 的光镜评估可以为临床决策提供信息,但缺乏经过验证的算法.
研究的目的:
- 为了评估一种新的光镜测量,以腹壁直径 (MBW:AWD) 标准化的中腔底部宽度和婴儿的手术内解剖学之间的相关性.
- 为了确定MBW:AWD比率是否可以准确地区分正常的肠道旋转与肠道旋转异常 (IRA).
主要方法:
- 在2013-2023年期间对婴儿 (<1岁) 进行的光学研究的回顾性审查,确定了DJJ和ICJ.
- 排除患有导致肠非旋转的先天性疾病的婴儿.
- 两个放射科医生独立测量了MBW (DJJ到ICJ) 和最大横向腹壁直径 (AWD).
- 计算MBW:AWD比率,并使用统计测试 (Wilcoxon排列和Kruskal-Wallis) 进行正常轮换婴儿和IRA婴儿之间的比较.
- 使用接收器操作特征 (ROC) 曲线分析确定最佳的MBW:AWD比率切线.
主要成果:
- 包括58名婴儿:22名正常旋转,36名IRA.
- 研究小组之间观察到,在手术前的X光照检查中,对不良旋转的担忧存在显著差异 (p < 0.0001).
- 与正常旋转 (0.65) (p < 0.0001) 的婴儿相比,IRA (0.31) 的婴儿的中位数MBW:AWD比率明显较低 (p < 0.0001).
- 一个最佳的MBW:AWD比率切线为0.55,证明了高的诊断准确性 (AUROC = 0.9578).
结论:
- MBW:AWD比率是可靠的放射性标志物,用于区分正常的肠道旋转和婴儿的IRA.
- 一个MBW:AWD比率为0.55可以作为有效的切断界限来识别IRA.
- 需要进一步验证,以确定该比率在管理偶然的IRA或上部胃肠道 (UGI) 研究的不确定的发现中的作用.
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