| Background:Short bowel syndrome (SBS) is a type of intestinal failure caused by intestinal resection leading to a shortened intestinal remnant and is characterized by the inability to maintain protein, energy, fluid, electrolyte, or micronutrient balances when on a conventionally accepted, normal diet. The remaining length of the small is an important clinical factor to develop and evaluate the treatment of short bowel syndrome, and it's also a decisive factor in the prognosis of SBS. Traditional barium contrast meal of measuring small bowel length is able to provide some diagnostic information for making clinical decisions of treating SBS, but intestinal adhesion and aggregation of the barium in the pelvic floor is the main cause of the inaccuracy of this length measurement.Purpose:Comparing the accuracy and relevance of different radiological and surgical measurement of the remnant in vivo small intestine length and diameter.Method: Multi-position short-interval whole digestive tract tracing double contrast barium and 3D surface reconstruction of CT imaging are used to measure the length and diameter of small bowel intestinal. The gold standard of the length measurement is based on the measuring of the length of the edge of bowel mesentery during laparotomy surgeries.Result:1.Among all the cases,30 patient's intestinal length is measured during surgeries, and there is statistically significance (p<0.05) between the length measured by surgeries and the double contrast barium radiological measurement. However there is no significant difference in measuring the intestinal length by surgeries or 3D CT simulation measurement.2.The 95% of the reference range for surgical length measuring group is (59.2,86.5) cm, and the double contrast barium length measurement is (42.5,59.3) cm, while the three-dimensional CT imaging small bowel intestinal length measurement is (60.9,89.4) cm.3.When the length boundary values is at 74.7cm, the length measuring sensitivity and specificity are 67.7% and 64.1%, the largest area under the ROC curve AUC is 0.663, standard error is 0.067, while 95%CI is 0.532-0.794.4.For the patients whose intraoperative length measurement of the small intestinal is more than 75cm (n= 14), the length measured by the whole gastrointestinal double contrast barium examination is shorter compared with the length measured during surgeries (p<0.05), while there is no difference between the surgery length measuring with CT three-dimensional imaging measuring technique (p>0.05).5.For the patients whose intraoperative length measurement of the small intestinal is less than 75cm (n= 25), there is no statistically significant difference between the whole gastrointestinal double contrast barium examination and the three-dimensional imaging techniques of measuring the intestinal length.6.For the children with short bowel syndrome, their remaining small intestines are 3.85 and 4.19cm, with a certain degree of expansion than the normal intestinal diameter.Conclusion:1.The conventional gastrointestinal double contrast barium technique is applicable for type ? short bowel syndrome patients to measure the remaining small bowel length.2.The CT 3D simulation imaging is applicable for type ? and ? short bowel syndrome patients to measure the remaining small bowel length. Supplemented with Foley catheter balloon filled in the stoma is also accurate for determining of the remaining length of the small intestine in patients with type ? short bowel syndrome, but with a poor tolerance to the patients.3.For patients with remaining small intestine length less than 75cm, the double contrast barium gastrointestinal imaging and the three-dimensional simulation CT imaging can both indicate the length of the short bowel.4.For patients with remaining small intestine length more than 75cm, the three-dimensional simulation CT imaging can better indicate the length of the short bowel compare with double contrast barium gastrointestinal imaging technique. |
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