320排CT诊断机械性肠梗阻的价值  

320-row CT in Diagnosis of Mechanical Ileus

作　　者：杨栋梁[1] 郑可国[2] 刘红艳[1] 彭旭红[1] 曲春瑜[1] 关秀红[1] 

机构地区：[1]清远市人民医院CT磁共振科,广东清远511500 [2]中山大学附属第一医院放射科,广东广州510080

出　　处：《中国医学影像学杂志》2016年第3期203-207,共5页Chinese Journal of Medical Imaging

摘　　要：目的机械性肠梗阻是临床常见的急腹症,本研究旨在探讨320排CT对机械性肠梗阻的诊断价值,提高术前诊断准确率。资料与方法纳入经手术证实为机械性肠梗阻的140例患者,其中单纯性肠梗阻97例,绞窄性肠梗阻43例。所有患者术前均行320排CT扫描并进行多平面重组(MPR)、曲面重组(CPR)、容积再现(VR),比较两组CT征象。统计CT诊断单纯性肠梗阻与绞窄性肠梗阻的敏感度、特异度、阳性预测值和阴性预测值。结果 140例患者151个梗阻点中,CT诊断149个移行带,敏感度为98.7%(149/151)。单纯性肠梗阻与绞窄性肠梗阻在移行带肠壁增厚、扩张肠袢肠壁增厚、肠壁气泡、肠壁内缘模糊、肠壁密度增高、肠壁强化减弱、附属系膜血管扩张、"鸟嘴征"、闭袢、"X征"、"漩涡征"、"小肠粪球征"方面比较,差异均有统计学意义(P<0.05),单纯性肠梗阻多见移行带肠壁增厚、"小肠粪球征",其余征象多见于绞窄性肠梗阻。320排CT诊断单纯性与绞窄性肠梗阻的准确度为92.1%(129/140),其中诊断绞窄性肠梗阻的敏感度、特异度、阳性预测值、阴性预测值分别为93.0%(40/43)、91.8%(89/97)、83.3%(40/48)、96.7%(89/92)。结论 320排CT对机械性肠梗阻具有较好的定位、定性诊断价值,为术前重要检查方法。Purpose Mechanical ileus is a common clinical acute abdomen. The present study was to explore the clinical value of 320-row CT in diagnosing mechanical ileus in order to improve preoperative diagnostic accuracy. Materials and Methods 140 patients with mechanical ileus confirmed by operation were collected, of whom 97 patients were with simple intestinal obstruction and 43 with strangulated intestinal obstruction. All of the patients were examined with 320-row CT scan and the multi-planar reconstruction（MPR）, curved planar reconstruction（CPR） and volume rendering（VR） were taken before the operations. Then the CT images of the two groups were compared; the sensitivity, specificity, positive predictive value and negative predictive value of two groups were all calculated. Results Altogether 151 transition zones were found in the 140 patients during the operations. Compared with the operational results, 149 transition zones were found by 320-row CT, which meant the sensitivity reached 98.7%（149/151）. The features like thick dilated bowel wall, bubbles in wall, blur inner edge of bowel wall, hyperattenuation of intestinal wall, lack of intestinal wall enhancement, mesenteric vasodilation, ＂beak＂ sign, closed loop, ＂X＂ sign and ＂whirl＂ sign were more likely seen in strangulated intestinal obstruction; while the features such as thick wall of transition zone and ＂bezoar＂ sign were more likely seen in simple intestinal obstruction. All the characteristics mentioned showed statistic difference（P〈0.05）. The accuracy rate of 320-row CT in differentiating simple from strangulated obstruction was 92.1%（129/140）, and the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing strangulated ileus were 93.0%（40/43）, 91.8%（89/97）, 83.3%（40/48） and 96.7%（89/92）, respectively. Conclusion The 320-row CT can locate mechanical ileus and provide qualitative information for its diagnosis, thus is regarded as an important preoperative examina

关 键 词：肠梗阻 体层摄影术 螺旋计算机 

分 类 号：R445.3[医药卫生—影像医学与核医学] R574.2[医药卫生—诊断学]