气腹CT腹膜腔三维仿真成像诊断术后腹腔粘连  

Three dimensional simulation imaging of peritoneal cavity based on pneumoperitoneum CT was used to diagnose postoperative peritoneal adhesion

作　　者：候利华 蔡晓军 HOU Lihua;CAI Xiaojun(Department of General Surgery,the Third Medical Central of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心普通外科,北京100039

出　　处：《临床外科杂志》2022年第4期349-352,共4页Journal of Clinical Surgery

摘　　要：目的探讨基于三维仿真成像的气腹CT诊断术后腹腔粘连的临床意义。方法腹部术后原因不明的慢性腹痛或复发机械性小肠梗阻病人826例,使用人工气腹CT扫描完成腹膜腔三维仿真成像影像并结合腹腔镜检进行临床诊断。结果826例病人中,602例表现穿越气腹空间、对抗重力位移的异常腹壁悬挂结构,被诊断为腹腔粘连,并通过腹腔镜检查证实。其余224例病人中,腹腔镜探查发现单纯脏性粘连12例。气腹CT诊断腹膜腔粘连的灵敏度和特异度分别为96.5%和100%。结论气腹CT容积再现法的腹膜腔三维成像,能够直观展示腹腔壁性粘连存在与否,但是显示脏性粘连能力相关性不佳,具有替代腹腔镜检查的功效。Objective To explore the clinical significance of three-dimensional simulation imaging based pneumoperitoneum CT in the diagnosis of postoperative abdominal adhesion.Methods 826 patients with unexplained chronic abdominal pain or recurrent mechanical small bowel obstruction after abdominal operation were selected.The clinical diagnosis was obtained by the use of three-dimensional simulation imaging of pneumoperitoneum CT obtained by manual scanning and assisted by laparoscopy.Results Pneumoperitoneum CT examination based on volume rendering method(volume render,VR)could realize three-dimensional imaging of peritoneal cavity and simulate the morphological characteristics of peritoneal cavity.In the 826 cases of pneumoperitoneum CT examination,602 cases showed abnormal abdominal wall suspension structure through pneumoperitoneum space and counterweight displacement,which was diagnosed as abdominal adhesion and confirmed by laparoscopy.Among the 224 cases without adhesions,12 cases with simple visceral adhesions were found by laparoscopy.The sensitivity and specificity of pneumoperitoneum CT were 96.5% and 100%,respectively.Conclusion The three-dimensional imaging of peritoneal cavity obtained by pneumoperitoneum CT could directly show the existence of abdominal wall adhesion or not,but has poor correlation with visceral adhesion,which had a certain effect of replacing laparoscopic examination.

关 键 词：腹部手术 腹腔粘连 复发性机械性小肠梗阻 慢性腹痛 人工气腹CT 容积再现 腹膜腔成像 腹腔镜 

分 类 号：R656[医药卫生—外科学]