X线、CT和消化内镜对克罗恩病诊断价值的评价  

Assessment of Diagnostic Value of X-ray ,CT and Digestive Endoscopy for Crohn＇s Disease

作　　者：朱庆强[1,2] 朱文荣[1,2] 王中秋[2] 史玉振[2] 童明敏[2] 林艳飞[2] 

机构地区：[1]南京军区南京总医院医学影像科,江苏南京210002 [2]徐州医学院研究生院

出　　处：《实用放射学杂志》2011年第5期729-733,767,共6页Journal of Practical Radiology

摘　　要：目的 探讨X线、CT及消化内镜对克罗恩病的诊断价值及其限度.方法 回顾性分析经病理、肠镜、手术证实的66例克罗恩病患者X线、CT及消化内镜表现,其中X线小肠＋结肠气钡双造影36例,窦道造影28例,全腹部CT平扫＋增强54例,消化内镜检查46例,同时行X线小肠＋结肠气钡造影和腹部窦道造影18例,行X线小肠＋结肠气钡造影和CT检查24例,行 X线小肠＋结肠气钡造影和消化内镜检查22例,行CT和消化内镜检36例.结果 36例小肠＋结肠气钡双造影中,多节段性病变24例（66.7%）,多发性、纵行裂隙状溃疡17例（47.2%）,卵石征16例（44.4%）,肠瘘4例（11.1%）,X线气钡双造影未显示肠壁增厚及腹腔脓肿、炎性包块等肠外并发症,对肠瘘的显示率亦不高.28例腹部窦道造影中,肠瘘20例（71.4%）,腹腔脓肿形成16例（57.1%）,窦道形成12例（42.8%）.54例CT检查,表现为肠壁增厚（＞4 mm）46 例（ 85.2%）,强化增加（＞20～30 HU） 42例（77.8%）,多节段性病变 39例（72.2%）,肠腔不规则狭窄38例（70.4%）,系膜区淋巴结肿大（＞5 mm）18例（ 33.3%）,系膜区血管束增多、增粗14例（25.9%）,肠管周围蜂窝织炎21例（38.9%）,腹腔内脓肿16例（29.6%）,炎性包块14例（25.9% ）,不全性肠梗阻22例（40.7%）,腹腔积液36例（66.7%）,瘘管形成8例（14.8% ）,CT未显示肠壁线形溃疡和卵石征,对肠瘘的显示率不高.46例消化内镜检查中,纵行裂隙状溃疡26例（56.5%）,铺路石样卵石征28例（60.8%）,肠腔不规则狭窄36例（78.3%）,多节段性病变34例（73.9%）,消化内镜未显示肠壁及肠外并发症等病症.结论 X线小肠＋结肠气钡造影,腹部窦道造影及CT 3种检查方法相互结合,对于克罗恩病的临床诊断及综合治疗具有重要价值.Objective To investigate the value and limits of X-ray, CT and digestive endoscopy in the diagnosis of Crohn＇s disease. Methods X-ray, CT and digestive endoscopic features of Crohn＇s diseases confirmed by pathology in 66 cases were retrospec- tively analyzed, in which thirty-six cases were examined with small bowel and colon X-ray, twenty-eight cases with sinus tract X-ray, fifty-four cases with CT, forty-six cases with digestive endoscopy, in addition,eighteen cases received both small bowel and colon X- ray and sinus tract X-ray, twenty-four cases received both small bowel and colon X-ray and CT,twenty-two cases received both small bowel plus colon X-ray and digestive endoscopy,thirty six cases received both CT and digestive endoscopy. Results Among the thirty-six cases of small bowel plus colon X ray examinations, there were twenty-four cases of segmental pathological changes（66.7 %）, seventeen of crack-like ulcers （ 47.2 % ） , sixteen o f cobblestones （ 44.4 % ） , four of intestinal fistula （ 11.1 % ） , but bowel wall and extraintestinal complication of Crohn＇s disease could not be showed. Among the twenty-eight cases with sinus tract X-ray examination,there were twenty cases of intestinal fistula （ 71.4 % ）, sixteen of peritoneal abscess （ 57.1 % ）, twelve of sinus tract（42.8 %） % Among the fifty-four eases examined with CT,there were forty-six cases （85.2%） of mural thickening （%4 mm）,forty-two cases （ 77.8 % ） of increased enhancement of bowel wall （ 〉 20- 30 H U ）, thirty nine cases （ 72.2 % ） of skip lesions , thirty-eight （ 70.4 % ） of irregular stenosis,eighteen cases（ 33.3% ） of mesenteric region lymphadenectasis（ %5 mm ） , fourteen cases （ 25.9 % ） of vascalar bundle thickening , tyenty-one cases（ 38.90//00 ）of dermatocellulitis , sixteen cases （29.6%） of peritoneal abscess, fourteen cases （ 25.9 % ） of phlogotie lump, twenty-two eases（40.7 % ） of incomplete intestinal obstruction, thirty-six cases （ 66.7 % ）

关 键 词：腹部 克罗恩病 X线摄影 体层摄影术 X线计算机 

分 类 号：R516.1[医药卫生—内科学] R814.41[医药卫生—临床医学]