胃肠道肿瘤性急腹症的影像学表现  

Imaging characteristics of gastrointestinal neoplastic acute abdomen

作　　者：张乐乐[1] 王海屹[1] Zhang Lele;Wang Haiyi(Department of Radiology,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院放射诊断科,北京100853

出　　处：《中华胃肠外科杂志》2018年第11期1223-1229,共7页Chinese Journal of Gastrointestinal Surgery

摘　　要：胃肠道肿瘤性急腹症可由胃部、小肠及结直肠的原发肿瘤引起,亦可由腹膜种植、淋巴道转移及血运来源的转移瘤所致。此类急腹症患者预后差,病死率高,临床表现复杂多变,临床做出正确诊断较为困难。不同肿瘤易引发的急腹症不相同。胃肠道恶性肿瘤常引起胃肠道梗阻,影像学检查建议首选上消化道造影检查(胃癌)及增强CT检查(结肠癌);胃肠间质瘤常伴有消化道出血,首选检查应为计算机断层扫描血管成像(CTA);原发性胃肠道淋巴瘤易引起胃肠道的穿孔.且好发于小肠.首选检查应为CT检查。小肠类癌发病率近年呈上升趋势,对于胃肠道缺血性急腹症,应及时行增强CT检查排除小肠类癌引起的胃肠道缺血。对于有肿瘤病史的患者若出现急腹症,也应考虑到胃肠道转移瘤的可能。本文重点讨论了常见的胃肠道肿瘤及其可引起的梗阻、穿孔及出血等急腹症的影像学特征,旨在提高临床工作中对此类症状的认识,以便及时做出正确的判断和治疗方式。Both malignant tumors derived from gastrointestinal tract and metastasis from peritoneal spread, hematogenous dissemination and lymph node can lead to acute abdomen.Such acute abdomen patients have poor prognosis, high mortality,and complex clinical manifestations.It is difficult to make a correct diagnosis in clinical practice. Recent studies show that gastrointestinal tumors are associated with clinical emergency.Malignant gastrointestinal tumors mostly result in obstruction,so upper gastrointestinal contrast for gastric cancer and post-enhanced CT for colon cancer are recommended;gastrointestinal stromal tumors usually cause bleeding,so computed tomography angiography (CTA) is the first choice for examination;primary gastrointestinal lymphoma tends to cause perforation and usually occurs in small intestine,so CT is the first examination for patients with ischemic acute abdomen,and post-enhanced CT is essential to exclude small intestine carcinoid because of its rising incidence in recent years.The possibility of gastrointestinal metastasis should be kept in mind for patients with cancer presenting acute abdomen.This article focuses on the imaging features of common gastrointestinal tumors and their acute obstruction,perforation,and hemorrhage,and aims to improve the understanding of such symptoms in clinical practice so that correct diagnosis and treatment can be made in time.

关 键 词：胃肠道肿瘤 梗阻 出血 穿孔 影像特征 

分 类 号：R735[医药卫生—肿瘤]