胆石性肠梗阻MSCT、MRI诊断及临床意义  

Clinical significance of MSCT and MRI diagnosis of gallstone ileus

作　　者：陈恩龙[1] 赵振国[1] 谢秀海[1] 隋海晶[1] 钱帮伟[1] 黄玉章[1] 

机构地区：[1]上海市浦东新区人民医院放射科,上海201299

出　　处：《实用放射学杂志》2013年第1期49-51,共3页Journal of Practical Radiology

基　　金：上海市浦东新区卫生系统领先人才培养基金（PWR12010-02）.

摘　　要：目的 探讨多层螺旋CT及MRI在胆石性肠梗阻诊断中的价值及临床意义。方法回顾分析17例经手术证实的胆石性肠梗阻病例的CT、MRI检查资料。17例均行CT检查，7例行MRI检查。结果多层螺旋CT显示肠梗阻共17例，不完全性小肠梗阻13例，完全性肠梗阻4例；异位结石17例，其中10例位于回肠，5例位于空肠，2例于胆囊及十二指肠内均可见结石，肌囊积气17例，胆管积气14例。17例中15例合并胆肠瘘，13例MSCT显示瘘口，7例行MRI检查，均可明确显示瘘口。结论多层螺旋CT及MRI在胆石性肠梗阻的定位和定性诊断中具有重要价值，可明确显示异位结石的数目、大小、位置，以及肠梗阻的梗阻位置及程度，还可直接显示胆肠瘘，尤其MRI对瘘口的明确显示有独特优势，为临床治疗方案的制订及颈后的判断提供全面的影像学信息。Objective To evaluate the clinical application and the value of multi-slice spiral CT（MSCT） and magnetic resonance imaging （MRI） in the diagnosis of gallstone ileus. Methods 17 patients of gallstone ileus obstruction confirmed by surgical findings, who had CT and MRI scans and clinical data were retrospectively reviewed. MSCT were performed in all patients. MRI were per formed in seven patients. Results MSCT showed intestinal obstruction in all cases,including incomplete small-howel obstruction in 13 cases and complete obstruction in 4 cases. Other findings included ectopic stone in 17 cases,of which 10 cases in the ileum,5 cases in the jejunum,2 cases with stones both in the gallbladder and the duodenum, pneumo-gallbladder in 17 cases, pneumobilia in 14 ca- ses. All gallstone obstruction patients, 15 cases showed biliary-enteric fistula, which were showed in 13 cases by MSCT, clearly showed in 7 cases by MRI. Conclusion MSCT and MRI are valuable for positioning and qualitative diagnosing gallstone ileus,which can provide comprehensive information regarding the exact number, size, and location of ectopic stones and the site of intestinal ob- struction or direct visualization of a biliary enteric fistula,especially MRI has a unique advantage in clearly showing lhe biliary-enteric fistula,and to help clinicians in the therapeutic management of patients and the judgment of prognosis.

关 键 词：胆结石 肠梗阻 计算机体层成像 磁共振成像 

分 类 号：R575.61[医药卫生—消化系统] R445.2[医药卫生—内科学]