medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-1386medvis-1386Research ArticleБРЮШНАЯ ПОЛОСТЬ И ЗАБРЮШИННОЕ ПРОСТРАНСТВОABDOMEN AND RETROPERITONEALПрогностические возможности КТ в диагностике хронических воспалительных осложнений дивертикулярной болезни ободочной кишкиPrognostic possibilities of CT in the diagnosis of chronic inflammatory complications of diverticular diseasehttps://orcid.org/0000-0003-2545-7966БеловД. М.BelovDenis M.

Белов Денис Мануэлевич – младший научный сотрудник, врач-рентгенолог ФГБУ “НМИЦ колопроктологии имени А.Н. Рыжих” Минздрава России, Москва

Denis M. Belov – Junior researcher, radiologist, National Medical Research Center of Coloproctology named after A.N. Ryzhikh, Moscow

belov_dm@gnck.ruhttps://orcid.org/0000-0002-9442-7480ЗароднюкИ. В.ZarodnyukIrina V.

Зароднюк Ирина Владимировна – доктор мед. наук, научный руководитель отделения рентгенодиагностики ФГБУ “НМИЦ колопроктологии имени А.Н. Рыжих” Минздрава России, Москва

Irina V. Zarodnyuk – Doct. of Sci. (Med.), scientific director of the X-ray diagnostics department, National Medical Research Center of Coloproctology named after A.N. Ryzhikh, Moscow

info@gnck.ruhttps://orcid.org/0000-0002-3038-1524МоскалевА. И.MoskalevAlexey I.

Москалев Алексей Игоревич – канд. мед. наук, руководитель научно-образовательного отдела ФГБУ “НМИЦ колопроктологии имени А.Н. Рыжих” Минздрава России, Москва

Alexey I. Moskalev – Cand. of Sci. (Med.), Head of Scientific and Educational department, National Medical Research Center of Coloproctology named after A.N. Ryzhikh, Moscow

info@gnck.ruhttps://orcid.org/0000-0001-8189-3071МайновскаяО. А.MaynovskayaOlga A.

Майновская Ольга Александровна – канд. мед. наук, руководитель отдела патоморфологии и иммуногистохимических исследований ФГБУ “НМИЦ колопроктологии имени А.Н. Рыжих” Минздрава России, Москва

Olga A. Maynovskaya – Cand. of Sci. (Med.), Head of the Department of Pathomorphology and Immunohistochemical Research, National Medical Research Center of Coloproctology named after A.N. Ryzhikh, Moscow

info@gnck.ruФГБУ ”НМИЦ колопроктологии имени А.Н. Рыжих“ Минздрава России; 123423 Москва, ул. Саляма Адиля, д.2, Российская ФедерацияРоссияNational Medical Research Center of Coloproctology named after A.N. RyzhikhRussian FederationФГБУ ”НМИЦ колопроктологии имени А.Н. Рыжих“ Минздрава России; 123423 Москва, ул. Саляма Адиля, д.2, Российская ФедерацияРоссияNational Medical Research Center of Coloproctology named after A.N. Ryzhikh; 2, Salyam Adil’ str., Moscow 123423, Russian FederationRussian Federation2024261220232826579Copyright © Белов Д.М., Зароднюк И.В., Москалев А.И., Майновская О.А., 20242024Белов Д.М., Зароднюк И.В., Москалев А.И., Майновская О.А.Belov D.M., Zarodnyuk I.V., Moskalev A.I., Maynovskaya O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/1386Цель исследования

Цель исследования: определить диагностическую эффективность компьютерной томографии (КТ) в прогнозировании течения заболевания у больных с хроническими воспалительными осложнениями дивертикулярной болезни (ДБ).

Материал и методы

Материал и методы. В исследование включено 70 пациентов с осложненным течением ДБ ободочной кишки в фазу обострения хронического воспалительного процесса. Всем пациентам выполнена КТ брюшной полости с внутривенным контрастированием для оценки вида и тяжести воспалительных изменений ободочной кишки и окружающих тканей в области локализации дивертикулов. Все пациенты получили консервативное лечение и находились под наблюдением в рамках проводимого исследования в течении 12 мес с момента первичного обращения в Центр. Оперативное вмешательство в связи с неэффективностью консервативной терапии или рецидивом воспалительного процесса в установленный период наблюдения рассматривалось как неблагоприятный исход заболевания (42/60%). Положительный эффект лекарственной терапии без признаков возврата клинической картины воспаления в течение 12 мес рассматривался как благоприятный исход (28/40%). Проведен статистический анализ КТ-признаков воспалительных изменений при различных исходах ДБ для выявления прогностических КТ-параметров.

Результаты

Результаты. Выявлены статистически значимые различия между выраженностью воспалительных изменений по данным КТ при различных исходах заболевания. В группе благоприятного исхода основную часть (23/28,82%) составили пациенты с дивертикулитом,  в группе неблагоприятного исхода у 2/3 больных (29/42,64%) диагностированы паракишечные инфильтраты, в том числе с абсцессами/полостями, и свищи ободочной кишки. Установлено, что толщина кишечной стенки, протяженность воспалительных изменений кишечной стенки, протяженность воспалительной инфильтрации периколической клетчатки, симптом “сороконожки”, скопление жидкости в периколической области статистически значимо различались при разных исходах хронических воспалительных осложнений ДБ. Многофакторный Кокс-регрессионный анализ выявил два основных предиктора  наступления неблагоприятного исхода – утолщение кишечной стенки и наличие жидкости в периколической области. Утолщение кишечной стенки при значениях, равных или более 0,6 см, в 4,69 раза увеличивало риск наступления неблагоприятного исхода, а наличие жидкости в 4,52 раза.

Заключение

Заключение. Применение в клинической практике выявленных КТ-предикторов наступления неблагоприятного исхода при хронических воспалительных осложнениях ДБ может послужить одним из факторов для принятия решения о плановом хирургическом вмешательстве у этой категории пациентов.

Objective: to determine the diagnostic effectiveness of computed tomography (CT) in predicting the course of the disease in patients with chronic inflammatory complications of diverticular disease (DD).Material and methods. The study included 70 patients with a complicated course of colon diverticular disease in the phase of exacerbation of the chronic inflammatory process. All patients underwent CT of the abdominal cavity with intravenous contrast to assess the type and severity of inflammatory changes in the colon and surrounding tissues in the area of localization of diverticula. All patients received conservative treatment and were monitored as part of the ongoing study for 12 months from the moment of initial treatment at the Center. Surgical intervention due to the ineffectiveness of conservative therapy or the recurrence of the inflammatory process during the established follow-up period was considered as an unfavorable outcome of the disease (42/60%). The positive effect of drug therapy without signs of a return of the clinical picture of inflammation within 12 months was considered as a favorable outcome (28/40%). A statistical analysis of CT signs of inflammatory changes in various DD outcomes was performed to identify prognostic CT parameters.Results. Statistically significant differences were revealed between the severity of inflammatory changes according to CT data for different outcomes of the disease. In the favorable outcome group, the main part (23/28.82%) were patients with diverticulitis, in the unfavorable outcome group, 2/3 of patients (29/42.64%) were diagnosed with pericolic infiltrates, including abscesses/cavities, and colon fistulas. It was found that the thickness of the intestinal wall, the extent of inflammatory changes in the intestinal wall, the extent of inflammatory infiltration of pericolic fiber, the symptom of “centipede”, the accumulation of fluid in the pericolic region statistically significantly differed with different outcomes of chronic inflammatory complications of diverticular disease. Мultivariate Cox proportional hazard model revealed two main predictors of the onset of an unfavorable outcome – thickening of the intestinal wall and the presence of fluid in the pericolic region. Thickening of the intestinal wall at values equal to or greater than 0,6 cm increased the risk of an unfavorable outcome by 4.69 times, and the presence of fluid by 4.52 times.Conclusion. The use in clinical practice of the revealed CT predictors of the onset of an unfavorable outcome in chronic inflammatory complications of DB can serve as one of the factors for deciding on elective surgery in this category of patients. 

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The authors declare that there are no conflicts of interest present.