十二指肠穿孔的CT诊断价值  

Diagnostic value of CT in duodenal perforation

作　　者：侯德志[1] 张平 石士奎[2] 刘振 黎海涛 HOU De-zhi;ZHANG Ping;SHI Shi-kui;LIU Zhen;LI Hai-tao(CT/MRI Division,People's Hospital of Dangshan County,Suzhou Anhui 235300,China;Department of Radiology,First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China;Department of Radiology,First Hospital Affiliated to Army Medical University,Chongqing 400038,China)

机构地区：[1]砀山县人民医院CT/MRI室,安徽宿州235300 [2]蚌埠医学院第一附属医院放射科,安徽蚌埠233004 [3]陆军军医大学第一附属医院放射科,重庆400038

出　　处：《局解手术学杂志》2019年第9期760-762,共3页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金(81171283);西南医院创新人才项目(SWH2015QN12)

摘　　要：目的 探讨十二指肠穿孔的CT表现及其诊断价值。方法回顾性分析安徽省砀山县人民医院2010年10月至2019年2月27例经手术证实的十二指肠穿孔患者的CT征象及临床资料。采用CT扫描膈顶至髂嵴,并结合多平面重建技术多方位观察寻找穿孔部位、原因、游离气体分布位置及邻近结构情况。结果27例患者穿孔部位均位于十二指肠球部,单发者26例,1例为十二指肠球前后壁同时穿孔。CT所见十二指肠腔外游离气体主要分布于肝周、胆囊窝、肝裂、肝肾间隙、肝胃间隙。除游离气体外,2例患者合并十二指肠球旁不规则软组织样高密度影,密度不均,与胆囊分界不清;9例可见腹腔积液;1例合并双侧胸腔积液。结论CT对十二指肠穿孔有重要诊断价值,对判断穿孔部位,推断穿孔的可能原因有明显优势。Objective To explore the CT manifestations and diagnostic value of duodenal perforation.Methods CT findings and clinical data of 27 patients with duodenal perforation confirmed by surgery in people's hospital of dangshan county from October 2010 to February 2019 were analyzed retrospectively.CT scan was performed from the diaphragmatic apex to the iliac crest,and the perforation site,causes,free gas distribution and adjacent structures were observed in multiple directions by combining with multi-plane reconstruction technology.Results All the 27 cases were perforated in the duodenal bulb,26 cases were isolated,and 1 case was perforated simultaneously in the anterior and posterior walls of the duodenal bulb.The free gas out of the duodenal cavity was mainly distributed around the liver,gallbladder fossa,hepatic fissure,liver and kidney space,liver and stomach space.In addition to free gas,2 patients were associated with irregular soft tissue high-density shadows near the duodenal bulb with uneven density and unclear boundary to the gallbladder,9 patients had seroperitoneum,and 1 patient had bilateral pleural effusion.Conclusion CT has important diagnostic value for duodenal perforation.It has obvious advantages to judge the perforation site and infer the possible cause of perforation.

关 键 词：十二指肠穿孔 膈下游离气体 断层摄影术 X射线计算机 

分 类 号：R604[医药卫生—外科学]