慢性血吸虫肠病的计算机断层扫描与病理对照分析  

Comparative study of computer tomography presentations and pathological results of chronic intestinal schistosomiasis

作　　者：张炜[1] 王培军[1] 沈星[2] 王国良[1] 江虹[1] 李萍[1] 

机构地区：[1]同济大学附属同济医院医学影像科,上海200065 [2]江苏省昆山市中医院放射科

出　　处：《中华传染病杂志》2012年第5期278-282,共5页Chinese Journal of Infectious Diseases

摘　　要：目的回顾性分析慢性血吸虫肠病患者的CT表现与病理特征。方法共纳入56例患者，男37例，女19例，平均年龄69．2岁，均行腹部CT平扫＋增强扫描，对病灶部位、形态、大小、钙化特点及强化方式进行评估；所有病例均经病理学检查证实为慢性血吸虫肠病，对其CT表现与病理学特点进行对照分析。结果CT扫描中56例慢性血吸虫肠病均发生在结肠，呈广泛管壁增厚，为0．3～1．2cm；表现为较均匀增厚43例，占76．8％。肠壁钙化可分为线状钙化42例，轨道状钙化19例，斑点状钙化8例。钙化边界清晰，全结肠见钙化灶5例，升结肠9例，横结肠12例，降结肠24例，乙状结肠直肠34例，直肠30例。17例患者肠管壁明显钙化。病理学证实，线状、轨道状钙化为虫卯广泛沉积于黏膜下层、浆膜下层所致，8例斑点状钙化及17例管壁明显钙化者，肠壁各层均可见钙化虫卯沉积，同时结肠壁有不同程度炎性细胞浸润、肉芽肿、纤维组织增生及息肉伴钙化虫卵沉积，并发腺癌5例。结论CT是显示慢性血吸虫肠病的重要影像学诊断方法，特征性表现为管壁较均匀增厚伴肠壁钙化，在此基础上出现管壁不规则增厚或伴软组织团块影，高度提示并发结直肠痛．Objective To retrospectively analyze the abdominal computer tomography （CT） findings and pathological results of chronic intestinal schistosomiasis in order to improve the diagnostic accuracy of the disease. Methods The plain plus enhanced CT scanning was performed in 56 cases （male 37, female 19; mean age 69.2 years）. All cases confirmed by pathological examination. The location, shape, size, calcification and pattern of enhancement of lesion were analyzed by two radiological physicians independently. Results The colon wall of all 56 cases was presented with thickening （0.3--1.2 cm） by CT scanning, among which, 43 （76.8~） were presented with welldistributed thickening. The calcification of colon wall included linear calcification （n= 42）, tram-like calcification （n = 19） and spot calcification （n = 8）. The margin of calcification was clear. The locations of calcification in colon were as follows., whole colon （n= 5）, ascending colon （n= 9）, transverse colon （n=12）, descending colon （n=24）, rectosigmoid （n=34） and rectum （n=30）. There were 17 cases presented with severe calcification. The pathological examinations confirmed that linear and tram-like calcification resulted from calcified ova deposited in submucous, subserosa. In 8 cases with spot calcification and 17 with severe calcification, there were calcified ova deposited in all layers of colon wall, accompanied by chronic inflammation, polyp and schistosomiasis granuloma. There were 5 cases complicated by adenocarcinoma. Conclusions CT scanning is an important imaging method in the diagnosis of chronic intestinal schistosomiasis, with the distinguishing presentation of well-distributed thickening and calcification in the colon wall. When irregular thickening, mass or nodular are found in the colon wall of patients with chronic intestinal schistosomiasis, colorectal carcinoma should be highly suspected.

关 键 词：血吸虫病 大肠 体层摄影术 X线计算机 钙质沉着症 

分 类 号：R532.2[医药卫生—内科学]