绞窄性肠梗阻的多层螺旋CT征象分析  

MSCT Signs in the Diagnosis of Strangulated Intestinal Obstruction

作　　者：肖运平[1] 韩秋丽[1] 邹莹[1] 颜俏燕[1] 

机构地区：[1]广西柳州市人民医院放射科,广西柳州545006

出　　处：《临床放射学杂志》2013年第5期672-675,共4页Journal of Clinical Radiology

摘　　要：目的探讨绞窄性肠梗阻的多层螺旋CT表现及其价值。方法回顾性分析诊断明确的32例绞窄性肠梗阻和85例单纯性肠梗阻患者的多层螺旋CT资料,结合文献筛选了7种绞窄性肠梗阻的CT征象:(1)肠壁强化减弱或无强化;(2)肠壁持续强化;(3)肠壁或门静脉积气;(4)肠壁增厚;(5)肠系膜血管充血;(6)肠系膜水肿/积液;(7)腹腔大量积液。比较上述CT征象在绞窄性肠梗阻与单纯性肠梗阻病例中的分布及诊断效能。结果上述7种CT征象在绞窄性肠梗阻病例中出现概率明显高于单纯性肠梗阻病例(P均<0.05);前3种征象只出现在绞窄性肠梗阻病例中,32例绞窄性肠梗阻患者中同时具备2项以上征象者占90.6%,85例单纯性肠梗阻患者中具备2项以上征象者仅3例,两组差异有明显统计学意义(χ2=88.752,P=0.000)。结论在诊断肠梗阻基础上,出现肠壁强化减弱或无强化、肠壁持续强化、肠壁或门静脉积气等征象之一或至少其他2种以上CT征象可提示为绞窄性。Objective To investigate the value of MSCT and various CT signs of strangulated intestinal obstruction.Methods 117 patients seen over a 5-year period with a MSCT diagnosis of intestinal obstruction were reviewed retrospectively,including 32 strangulated patients and 85 single patients proved by surgery or clinical diagnosis.Images were interpreted prospectively with consensus by two experienced radiologists.Attention was focused on the presence of the following CT signs of strangulation and ischemia： reduced or absent enhancement of bowel wall;persistent enhancement of bowel wall on contrast-enhanced CT scans;pneumatosis intestinalis and portomesenteric venous gas;mural thickening;mesenteric vascular engorgement;diffuse mesenteric haziness;and a large amount of ascites.Distribution and diagnostic efficacy of above-mentioned CT signs were compared in strangulated intestinal obstruction group with single intestinal obstruction group.Results Appearance probability of above-mentioned CT signs were visibly higher in strangulated intestinal obstruction group than that in single intestinal obstruction group（P0.05）.Three previous CT signs presented only in trangulated intestinal obstruction group.There were 29 patients which were found with at least two of above-mentioned signs in strangulated intestinal obstruction group,whereas there were 3 patients in single intestinal obstruction group.There was significant difference between strangulated intestinal obstruction group and single intestinal obstruction group（χ2=88.752,P=0.000）.Conclusion After a diagnosis of intestinal obstruction with MSCT,a diagnosis of strangulation and ischemia can be made if one of three previous signs or if at least two of the other signs were found.

关 键 词：体层摄影术 X线计算机 肠梗阻 绞窄性 诊断 

分 类 号：R656.7[医药卫生—外科学]