多层螺旋CT对回盲部急腹症病变的诊断意义  

Diagnostic value of multi-slice spiral CT in lesions of ileocecal acute abdomen

作　　者：赵明一[1] 陈涛[1] ZHAO Ming-yi;CHEN Tao(Department of General Surgery,People′s Hospital of Daxing District in Beijing City,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院普外科,北京102600

出　　处：《中国当代医药》2018年第18期80-82,共3页China Modern Medicine

摘　　要：目的探讨多层螺旋CT(multi-slide CT,MSCT)对回盲部急腹症病变的诊断价值,以期指导该类疾病的快速诊断。方法回顾性分析2016年1月~2017年12月我院收治的97例疑似回盲部急腹症病变患者的临床资料,所有患者术前均行MSCT检查。以手术证实结果作为金标准,评价MSCT诊断回盲部急腹症病变的价值;同时分析不同回盲部急腹症CT表现。结果本组97例疑似回盲部急腹症病变患者中有85例确诊,12例排除,其中阑尾炎52例,肠套叠20例,憩室炎13例。MSCT诊断阑尾炎、肠套叠、憩室炎的敏感度、特异度、阳性预测值、阴性预测值和符合率分别为88.46%、66.67%、95.83%、40.00%和86.21%,85.00%、66.67%、94.44%、40.00%和82.61%,92.31%、100.00%、100.00%、75.00%和93.75%。MSCT与手术诊断总符合率为86.60%。阑尾炎主要CT表现为阑尾外径显著增粗,周围炎性改变并可见渗液,周围脂肪层内可见片絮状或条纹状密度等高影,边界模糊不清;阑尾穿孔者可见穿孔被网膜包被形成包块样结构,中心形成低密度、壁较厚且不均匀。肠套叠CT下可见肿瘤样改变,且与炎症同时出现,套叠肠管于CT扫描垂直时包块影表现为圆形或环形,包块内可见层状结构;套叠肠管于CT扫描不垂直时表现为明显"双肠管征"和"彗星尾征"。憩室炎CT表现为憩室周围炎症浸润,可见渗出影和脂肪层增厚;严重时可见憩室出血、穿孔,并合并有局部脓肿。结论 MSCT技术对阑尾炎、憩室炎、肠套叠等回盲部急腹症病变的检出率与手术病理诊断一致性高,能清晰显示病灶及周围脏器和组织受累情况,可作为回盲部急腹症病变首选的检查手段在临床进行推广和应用。Objective To explore the diagnostic value of multislice spiral CT(MSCT)for the acute abdominal disease in the ileocecal region in order to guide the rapid diagnosis of this kind of disease.Methods The clinical data of 97 patients with suspected ileocecal acute abdomen admitted to our hospital from January 2016 to December 2017 were retrospectively analyzed.All patients were examined by MSCT before operation.Taken surgical results as standard:the value of MSCT in diagnosing acute ileocecal lesions was evaluated.At the same time,the CT manifestations of acute abdomen in different ileocecal parts were analyzed.Results Among the 97 cases of suspected ileocecal acute abdomen,85 cases were diagnosed and 12 cases were excluded:including in 52 cases of appendicitis,20 cases of intussusception and 13 cases of diverticulitis.The sensitivity,specificity,positive predictive value,negative predictive value and coincidence rate of appendicitis,intussusception and diverticulitis were 88.46%,66.67%,95.83%,40.00%,86.21%and 85.00%,66.67%,94.44%,40.00%,82.61%and 92.31%,100.00%,100.00%,75.00%,86.21%.The total coincidence rate of MSCT and surgical diagnosis was 86.60%.The main CT of appendicitis is the obvious thickening of the outer diameter of the appendix,the surrounding inflammatory changes and the permeation of the appendectomy.The perforation of the appendix is perforated by the omentum,forming a lump like structure.The center is low density and thick and uneven.The tumor like changes were seen under the intussusception CT and appeared at the same time with inflammation.The mass of the intussusception was round or ring when the CT scan was vertical.The lump was visible in the lump.The intussusception tube showed obvious“double bowel sign”and“comet tail sign”when CT scanning was not vertical.Diverticulitis CT showed inflammatory infiltration around the diverticulum,showing exudation and thickening of the adipose tissue.In severe cases,diverticulum hemorrhage,perforation and local abscess were seen.Conclusion The detectio

关 键 词：多层螺旋CT 急腹症病变 回盲部 阑尾炎 肠套叠 憩室炎 

分 类 号：R656.1[医药卫生—急诊医学]