胆石性肠梗阻患者CT影像学特征及其手术指导价值分析  

Analysis of CT Imaging Features and Surgical Guidance Value in Patients with Gallstone Ileus

作　　者：董瑞生[1] 王效然[2] 王瑞玲[3] DONG Rui-sheng;WANG Xiao-ran;WANG Rui-ling(CT Room,Fenyang Hospital of Shanxi Province(Fenyang Hospital Affiliated to Shanxi Medical University),Fenyang 032200,Shanxi Province,China;Department of housing management,Fenyang Hospital of Shanxi Province(Fenyang Hospital Affiliated to Shanxi Medical University),Fenyang 032200,Shanxi Province,China;Digestive endoscopy room,Fenyang Hospital of Shanxi Province(Fenyang Hospital Affiliated to Shanxi Medical University),Fenyang 032200,Shanxi Province,China)

机构地区：[1]山西省汾阳医院(山西医科大学附属汾阳医院)CT室,山西汾阳032200 [2]山西省汾阳医院(山西医科大学附属汾阳医院)房管科,山西汾阳032200 [3]山西省汾阳医院(山西医科大学附属汾阳医院)消化内镜室,山西汾阳032200

出　　处：《中国CT和MRI杂志》2022年第8期157-159,共3页Chinese Journal of CT and MRI

摘　　要：目的研究胆石性肠梗阻(GI)患者的计算机断层扫描(CT)影像学特征及其手术指导价值。方法选取2017年12月至2020年12月我院收治的64例经手术证实的GI患者,术前均行腹部CT检查和腹部X线检查,分析其影像学特征,以手术结果为金标准,评估两种检查方法的诊断效能。结果64例GI患者中,手术证实不完全性肠梗阻36例(56.2%),完全性肠梗阻28例(43.8%);术前X线检出GI 38例(59.4%),影像显示肠梗阻改变包括肠管扩张、积气积液、气液平64例(100%),胆道积气34例(53.1%),异位胆石13例(20.3%);术前CT检出GI 62例(96.9%),影像显示肠梗阻改变64例(100%),胆道积气54例(84.4%),胆囊内残余结石29例(45.3%),胆囊十二指肠瘘31例(48.4%),胆总管结石34例(53.1%),肠腔异位结石含钙化高密度62例(96.9%);CT对胆道积气和异位胆石的检出率分别为84.4%、96.9%,显著高于X线(53.1%、20.3%,P<0.05);CT诊断完全性肠梗阻的灵敏度为97.2%,特异度为96.4%,阳性预测值为97.2%,阴性预测值为96.4%,Kappa值为0.936;X线诊断完全性肠梗阻的灵敏度为30.5%,特异度为46.4%,阳性预测值为42.3%,阴性预测值为34.2%,Kappa值为0.221。结论CT检查可以快速明确诊断GI,同时显示异位结石的形态、大小、数目、位置及梗阻点周围情况,为治疗方案的制定提供重要的影像信息。Objective To study the imaging features of computed tomography(CT)and their diagnostic value in patients with gallstone ileus(GI)and its surgical guidance value.Methods 64 GI patients who were confirmed by surgery in the hospital between December 2017 and December 2020 were enrolled.All underwent abdominal CT examination and X-ray examination before surgery.Their imaging features were analyzed.Taking the surgical results as the golden standard,diagnostic efficiency of the two methods was evaluated.Results Among the 64 GI patients,it was confirmed by surgery that there were 36 cases(56.2%)with incomplete ileus and 28 cases(43.8%)with complete ileus.Among the 64 GI patients,38 cases(59.4%)were diagnosed as GI by X-ray examination before surgery.There were 64 cases(100%)with ileus changes(intestinal dilatation,gas accumulation and hydrops,gasliquid equilibrium),34 cases(53.1%)with gas accumulation of biliary tract,and 13 cases(20.3%)with allotriolith.Among the 64 GI patients,62 cases(96.9%)were diagnosed as GI by CT examination before surgery.There were 64 cases(100%)with ileus changes,54 cases(84.4%)with gas accumulation of biliary tract,29 cases(45.3%)with residual stones in gallbladder,31 cases(48.4%)with gallbladder duodenal fistula,34 cases(53.1%)with choledocholithiasis,and 62 cases(96.9%)with ectopic intestinal stones with high-density calcification.The detection rates of biliary gas and ectopic gallstones by CT were 84.4%and 96.9%,respectively,higher than those by X-ray(53.1%and 20.3%,P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and Kappa value of CT and X-ray in the diagnosis of complete ileus were(97.2%,96.4%,97.2%,96.4%,0.936)and(30.5%,46.4%,42.3%,34.2%,0.221),respectively.Conclusion CT examination can quickly and clearly diagnose GI,which can display its shape,size,number,sites and surrounding conditions at ileus sites.It can provide important imaging information for the formulation of clinical treatment plans.

关 键 词：胆石性肠梗阻 计算机断层扫描 X线 影像特征 诊断 

分 类 号：R574.2[医药卫生—消化系统]