多排螺旋CT检查对肠梗阻肠道缺血评估与治疗决策的价值  

Multi-slice spiral CT （MSCT） ： value of evaluating intestinal ischemia and therapeutic strategy for patients with intestinal obstruction

作　　者：王睿轲 冯智超[2] 蒲涛[2] 张声旺[2] 

机构地区：[1]中南大学湘雅医学院,长沙410013 [2]中南大学湘雅三医院放射科,长沙410013

出　　处：《中国医师杂志》2016年第8期1143-1147,共5页Journal of Chinese Physician

摘　　要：目的 探讨肠梗阻患者临床表现及多排螺旋CT征象对肠梗阻肠道血运评估能力及对临床治疗决策的指导价值.方法 接受多排螺旋CT检查并经手术和（或）血管造影证实为肠梗阻患者746例.根据患者最终诊断分为有血运障碍的高危组（n=70）和无血运障碍的非高危组（n=676）.根据手术确认肠管是否坏死将高危组分为坏死组（n=31）和无坏死组（n=39）.统计临床表现的主要征象和CT表现重要征象在评估可能的肠道缺血及肠壁坏死的诊断价值.结果 在评价肠梗阻有无肠道缺血的征象中,增强肠壁无全层强化（敏感度0.86、特异度0.99）、肠壁增厚、平扫肠壁密度减低敏感度和特异度均较高,肠道扩张积气积液敏感度高但缺乏高特异度,肠壁或血管内气体特异度高但缺乏高敏感度.肠系膜密度增高（水肿）也是诊断肠道缺血的重要CT征象.合并肠系膜血管充盈缺损是诊断肠道缺血特异性很高的CT征象.CT评估高危组中肠管坏死各项指标中敏感度及特异度均较高的指标有增强肠壁全层不强化（敏感度0.93、特异度0.69）、肠系膜密度增高水肿（敏感度0.97、特异度0.64）、肠系膜血管充盈缺损（敏感度0.78、特异度0.92）、腹水（敏感度0.77、特异度0.92）.结论 肠梗阻患者多排螺旋CT征象对评估肠道血运障碍及肠管坏死有重要意义,其诊断价值明显高于单纯临床表现,可以对临床治疗决策进行有价值的指导.Objective To explore early signs of strangulated bowel with multi-slice spiral CT （MSCT）,and the ability of this diagnostic modality to indicate when surgical management is required for intestinal obstruction with ischemia.Methods A total of 746 patients of intestinal obstruction were investigated with MSCT scan.The final diagnosis was confirmed by surgery and/or angiography.According to the final diagnosis,those cases were divided into ischemia groups （n =70） and no ischemia group （n =676）.According to surgical findings,the cases in ischemia group was divided into necrosis group （n =31） and no-necrosis group （n =39）.The clinical manifestations,CT signs,and surgical/angiography findings were retrospectively evaluated in this study.Results Among the typical MSCT signs for evaluating intestinal ischemia of intestinal obstruction,no enhancement,thickening,and reduced unenhanced attenuation of bowel wall had relatively high sensitivity and specificity.However,intestinal expansion,pneumatosis and effusion was absence of high specificity,and gas in bowel wall or mesenteric vascular was absence of high sensitivity.Mesenteric congestion was another important sign for intestinal ischemia.Filling defect in mesenteric vascular was highly specific to diagnosis intestinal ischemia.The MSCT signs to assess intestinal necrosis in moderate-high risk intestinal obstruction included no enhancement of bowel wall （sensitivity 0.93,specificity 0.69）,mesenteric congestion （sensitivity 0.97,specificity 0.64）,filling defect in mesenteric vascular （sensitivity 0.78,specificity 0.92）,and ascites （sensitivity 0.77,specificity 0.92）.Conclusions MSCT is an important non-invasive examination in diagnosing intestinal blood perfusion disorder and intestinal necrosis.It is much more valuable to bowel obstruction assessment than the value of symptom and physical examinations of the patient.It can provide valuable guidance to treatment strategy of bowel obstruction patient.

关 键 词：体层摄影术 螺旋计算机 肠梗阻/并发症/放射摄影术/治疗 缺血/并发症/放射摄影术/治疗 

分 类 号：R574.2[医药卫生—消化系统] R816.5[医药卫生—内科学]