阑尾术后肠粘连气腹造影的CT影像特征及其临床价值  

Diagnostic value of pneumoperitoneum contrast helical computed tomography imaging for peritoneal adhesions after appendectomy

作　　者：段亮[1] 蔡晓军[2] 韩承新[2] 张新国[1] 严建宇[3] 曹策[1] 郭晓博[1] 刘勇[1] 李晗[1] 

机构地区：[1]辽宁医学院研究生学院,辽宁省锦州市121001 [2]中国人民解放军武警总医院,北京市100039 [3]中国人民解放军武警新疆总队医院,新疆维吾尔自治区乌鲁木齐市830091

出　　处：《世界华人消化杂志》2009年第32期3355-3359,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨阑尾术后肠粘连气腹造影的CT影像特征及其临床价值.方法:20例术后慢性腹痛,腹胀或有机械性肠梗阻反复发作的疑诊阑尾手术后肠粘连患者.采用深静脉穿刺导管或18号软套管针注气后行腹部CT扫描,对影像特征进行解析、分类.结果:2例患者(因急诊)未行该检查,2例患者行该检查未成功,16例患者均表现有腹壁粘连的影像特征,腹内脏器局部隆起,跨越气腹空间与腹壁贴附.粘连的脏器有大网膜、小肠、结肠.根据粘连的脏器及范围可分为局限性大网膜粘连10/16(62.5%)、局限性肠管粘连5/16(31.3%)和全腹弥漫性粘连1/16(0.7%).其中9例患者行经腹腔镜肠粘连松解术,2例行腹腔镜部分松解术结合小切口开腹手术,2例急诊行剖腹探查术(其中1例表现有网膜粘连,另1例无粘连).手术患者与气腹造影腹部CT平扫结果完全一致.结论:气腹造影CT检查安全、简便易行,多平面重建图有助于腹壁粘连的直观显示.AIM：To evaluate the clinical value o f pneumoperitoneum contrast helical computed tomography（PCHCT）imaging in the diagnosis of peritoneal adhesions after appendectomy （PAAP）. METHODS：Twenty consecutive patients with suspected PAAP（presence of symptoms such as chronic abdominal pain,abdominal distention or mechanical obstruction）were examined by PCHCT.The images obtained were analyzed and classified.RESULTS：Of all patients included,two did not undergo PCHCT due to emergency conditions,two underwent unsuccessful PCHCT,and the other 16 underwent successful PCHCT and showed the imaging features of abdominal wall adhesions：intra-abdominal organs are locally elevated,span across the pneumoperitoneum space and are attached to abdominal wall.The organs that were attached include the large omentum,small intestine and colon.According to the organs attached and adhesion extent,three types of adhesions were noted：limited omental adhesion（10/16,62.5%）,limited intestinal adhesion（5/16,31.3%）,and extensive abdominal adhesion（1/16,0.7%）.Nine patients underwent laparoscopic adhesiotomy,two patients underwent partial laparoscopic adhesiotomy and minilaparotomy,and two patients underwent emergency laparotomy.The surgical findings are fully consistent with the diagnostic results of PCHCT. CONCLUSION：PCHCT is safe and simple and permits multi-planar reconstruction that can enhance the visualization of abdominal wall adhesions.

关 键 词：气腹造影 螺旋CT 阑尾炎术后腹壁粘连 诊断 

分 类 号：R656.8[医药卫生—外科学] R816.5[医药卫生—临床医学]