国际医学放射学杂志2026，Vol.49Issue(3)：259-266,8.DOI:10.19300/j.2026.L22477
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
Correlation between CT-measured esophageal hiatus surface area and intraoperative measurements in patients with hiatal hernia
摘要
Abstract
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.关键词
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Key words
Hiatal hernia/Esophageal hiatus area/Multiplanar reconstruction/Tomography,X-ray computed分类
医药卫生引用本文复制引用
张舒悦,徐新,宫琰,刘忠杰,吴瑜,张翔..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[J].国际医学放射学杂志,2026,49(3):259-266,8.基金项目
北京医学奖励基金项目(YXJL-2024-0778-0019) （YXJL-2024-0778-0019）
天津市教委科研计划项目(2023KJ055) （2023KJ055）
