CT测量食管裂孔疝病人裂孔表面积与术中对照的相关性研究OA
Correlation between CT-measured esophageal hiatus surface area and intraoperative measurements in patients with hiatal hernia
目的 探究CT多平面重组技术联合双斜校正技术测量食管裂孔疝病人的食管裂孔表面积(HSA)与手术中测量HSA的一致性和相关性,并构建术后并发症的预测模型.方法 回顾性纳入行食管裂孔疝修补术的病人198例.基于CT后处理技术测量病人的HSA,并与术中测量结果进行对照分析.根据病人食管裂孔疝的不同类型分为滑动疝组(127例)和其他类型疝组(包括食管旁疝、混合疝和巨大疝,71例).采用Bland-Altman分析与Spearman相关性分析2组病人CT和术中测量HSA的一致性及相关性.根据确诊时间将病人分为测试集(110例)和内部验证集(88例),基于测试集数据利用二元 Logistic回归分析多种术后并发症的预测因素,并基于多因素Logistic回归构建术后并发症预测的联合模型并进行验证.采用受试者操作特征曲线下面积(AUC)评估各因素及联合模型的预测效能.采用DeLong检验比较模型的AUC.采用校准曲线和决策曲线评估联合模型的校准度和临床净获益.结果 滑动疝组CT测量值与术中测量值相关性较高(ρ=0.84,P<0.001),且一致性较好(一致性界限为:-0.95～1.40).训练集中,二元Logistic回归分析结果显示年龄、吸烟史、CT测量HSA和术中测量HSA是术后并发症发生的独立预测因子(P<0.05).构建联合模型并与各单一因素的预测效能进行比较,结果显示联合模型在训练集的预测效能最高(AUC=0.88),并在验证集中得以验证(AUC=0.87).校准曲线及决策曲线分析进一步表明,联合模型预测术后并发症的概率和实际结果一致性较好,临床净获益较高.结论 CT测量HSA与术中测量相关性和一致性较高,联合临床因素(年龄、吸烟史等)建立术后并发症预测模型,能够为术后并发症预防提供重要信息.
Objective To evaluate the agreement and correlation between esophageal hiatus surface area(HSA)measured using computed tomography(CT)-based multiplanar reconstruction combined with double-oblique correction and intraoperative HSA measurements in patients with hiatal hernia,and to establish a predictive model for postoperative complications.Method A retrospective analysis was conducted in 198 patients who underwent hiatal hernia repair.HSA was quantified using CT post-processing techniques and compared with intraoperative measurements.According to hernia subtype,patients were categorized into a sliding hernia group(127 cases)and an other-type hernia group(71 cases),including paraesophageal hernia,mixed hernia,and giant hernia.Bland-Altman analysis and Spearman correlation analysis were performed to assess the agreement and correlation between CT-derived and intraoperatively measured HSA.Based on the time of diagnosis,patients were further divided into a training cohort(110 cases)and an internal validation cohort(88 cases).Binary logistic regression analysis was performed in the training cohort to identify independent predictors of postoperative complications.A multivariable predictive model was subsequently constructed and validated.The predictive performance of individual predictors and the combined model was assessed using the area under the receiver operating characteristic curve(AUC).Differences in predictive performance were compared using the DeLong test.Calibration curves and decision curve analysis were used to evaluate model calibration and clinical utility.Results In the sliding hernia group,CT-derived HSA demonstrated a strong correlation with intraoperative measurements(ρ=0.84,P<0.001)and good agreement,with limits of agreement ranging from-0.95 to 1.40.In the training cohort,binary logistic regression analysis identified age,smoking history,CT-measured HSA,and intraoperative HSA as independent predictors of postoperative complications(all P<0.05).A combined predictive model incorporating these variables achieved superior predictive performance compared with individual predictors alone,with an AUC of 0.88 in the training cohort and 0.87 in the validation cohort.Calibration and decision curve analyses further demonstrated good consistency between predicted and observed probabilities,as well as favorable clinical net benefit.Conclusion CT-derived HSA demonstrates strong correlation and agreement with intraoperative measurements.A predictive model integrating CT-derived HSA with clinical risk factors,including age and smoking history,may provide valuable information for risk stratification and prevention of postoperative complications in patients with hiatal hernia.
张舒悦;徐新;宫琰;刘忠杰;吴瑜;张翔
天津中医药大学医学技术学院,天津 301617天津医科大学附属南开医院医学影像科天津医科大学附属南开医院医学影像科天津医科大学附属南开医院胃肠外三科天津医科大学附属南开医院胃肠外三科天津医科大学附属南开医院医学影像科
医药卫生
食管裂孔疝食管裂孔表面积多平面重组体层摄影术,X线计算机
Hiatal herniaEsophageal hiatus areaMultiplanar reconstructionTomography,X-ray computed
《国际医学放射学杂志》 2026 (3)
259-266,8
北京医学奖励基金项目(YXJL-2024-0778-0019)天津市教委科研计划项目(2023KJ055)
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