腹膜透析后包裹性腹膜硬化的CT诊断及鉴别  

CT features and differential diagnosis of encapsulating peritoneal sclerosis after peritoneal dialysis

作　　者：张繁 关键[2] 林芝[2] 王焕军[2] 肖煦阳 张皓钦 郭燕[2] 陈应明[2] ZHANG Fan,GUAN Jian,LIN Zhi(Department of Radiology,the First Affiliated of Sun Yat-sen University,Guangzhou 510080 ,Chin)

机构地区：[1]中山大学附属第一医院东院放射科,广州510080 [2]中山大学附属第一医院放射科,广州510080

出　　处：《放射学实践》2018年第5期468-472,共5页Radiologic Practice

基　　金：广东省自然科学基金(2017A030313902);广东省医学科学技术研究基金(A2017008)

摘　　要：目的:探讨腹膜透析(PD)后包裹性腹膜硬化(EPS)的CT表现特点,提高疾病诊断水平。方法:搜集临床证实为EPS的24例患者,24例均行1~3次CT平扫。回顾性分析其影像表现,结合临床分型,按CT表现分为轻症EPS和重症EPS,对PD时间、腹膜厚度、腹膜钙化、腹部血管钙化、肠道并发症及其他并发症进行评估。结果:24例患者持续PD病史为3~17年,在PD时间超过5年的患者中,重症EPS的发生率明显增高;PD时间超过10年的患者均为重症EPS。24例患者中轻症EPS 14例,平均PD时间为(6.1±2.4)年,CT表现为壁层腹膜游离缘增厚,厚度为2.5~5.0mm;小肠壁肠系膜缘增厚,厚度为8~10mm;壁层腹膜边缘钙化,钙化散在分布,呈斑点状,小于5处。重症EPS 10例,平均PD时间为(9.9±4.7)年,表现为广泛的壁层和脏层腹膜、大网膜和肠系膜增厚,厚度大于5.0mm;小肠壁弥漫增厚,厚度大于10mm;合并壁层和脏层腹膜、大网膜、肠系膜及小肠壁多发钙化,钙化范围广泛,呈轨道状、短线状、簇状、团块状。重症EPS合并肠粘连2例、动力性肠梗阻8例,其他并发症包括腹壁疝2例、血肿1例及包裹性积液2例。轻、重症EPS均可出现腹部血管钙化。结论:EPS的CT表现有一定的特征性,结合长期PD病史,可作出诊断及分型。Objective：This study was performed to present and analyze the CT features of encapsulating peritoneal sclerosis（EPS）undergoing continuous ambulatory peritoneal dialysis（PD）and to improve the diagnostic level.Methods：Twenty-four patients clinically confirmed as EPS and all underwent non-enhanced abdominal CT scan for one to three times.The images were retrospectively analyzed.Combined with the clinical classification criteria and based on CT manifestations,EPS were divided into two categories of mild and severe.The average the duration of time on peritoneal dialysis,thickness of peritoneum,number and distribution of peritoneal calcification,abdominal vascular calcification,intestinal complications and other complications were evaluated.Results：24 patients had continuous PD history of 3～17 years.The incidence of severe EPS increased significantly in patients with PD over 5 years.The patients with PD over 10 years were all assigned to severe EPS.Among the 24 patients,there were 14 mild EPS cases with average（6.1±2.4）years of PD history,and their CT images showed a thickening of the free edge of the parietal peritoneum with a thickness of 2.5～5.0 mm,a thickening of the mesenteric margin of the intestinal wall with a thickness of 8～10 mm,and the scattered spotted calcification of the parietal peritoneum with the number less than five.The study included 10 severe EPS cases with average（9.9±4.7）years of PD history,which was characterized by as follows：extensive thickening of parietal and visceral peritoneum,greater omentum and mesentery,with the thickness greater than 5.0 mm;diffuse thickening of intestinal wall,with the thickness greater than 10 mm;wide range calcification of parietal and visceral peritoneum,omentum,mesentery and small bowel wall,with the shape of orbits,short line,clustered and lumpy structure.Severe EPS was accompanied with 2 cases of intestinal adhesion and 8 cases of dynamic intestinal obstruction.Other complications included 2 cases of abdominal wall hernia,1 case o

关 键 词：腹膜透析 包裹性腹膜硬化 体层摄影术 X线计算机 腹膜 钙化 

分 类 号：R572.2[医药卫生—消化系统] R814.42[医药卫生—内科学]