小肠梗阻手术指征的磁共振成像评价价值研究  

Study on the evaluation value of magnetic resonance imaging for surgical indications of small intestinal obstruction

作　　者：王任水 曲林涛[2] 戴云秀 程永远[2] WANG Ren-shui;QU Lin-tao;DAI Yun-xiu(Functional Department,Laiyang Center Hospital of Yantai,Yantai 265200,China)

机构地区：[1]烟台市莱阳中心医院功能科,265200 [2]烟台市莱阳中心医院放射科,265200

出　　处：《中国实用医药》2025年第2期84-87,共4页China Practical Medicine

基　　金：山东省医药卫生科技发展计划项目(项目编号:202109010240);烟台市科技创新发展计划项目(项目编号:2022YD117)。

摘　　要：目的评价磁共振成像(MRI)中“C”形征、多腹腔间隙积液对小肠梗阻手术指征的诊断价值。方法回顾性分析55例粘连性小肠梗阻患者的磁共振成像影像资料,其中手术患者25例,非手术患者30例。手术患者中有17例肠梗阻均经手术证实为绞窄性肠梗阻,30例非手术患者均经保守治疗好转,最终临床均诊断为粘连性小肠梗阻。分析小肠梗阻的磁共振成像影像征象特点;分析磁共振成像征象“C”形征和多腹腔间隙积液对小肠梗阻是否需要手术的诊断效能。结果25例手术患者梗阻肠管不同程度扩张,平均扩张程度为(3.90±0.73)cm,均可见盆腔、结肠旁沟或肠间隙等多腹腔间隙积液,其中17例患者可见梗阻近侧扩张小肠局部弯曲呈“C”形,称“C”形征。术中可见小肠广泛扩张水肿,梗阻中间段肠管坏死僵硬,腹部可见血性腹水;病理可见梗阻中间段小肠肠壁增厚,小肠黏膜面出血呈暗红色、严重者可见黏膜坏死脱落,黏膜下层水肿出血,部分浆膜面亦见渗出物附着,血管充血、出血。磁共振成像征象显示“C”形征对于小肠梗阻是否需要手术的诊断灵敏度为68.00%,特异度为100.00%,约登指数为0.68,阳性预测值为100.00%,阴性预测值为78.95%;多腹腔间隙积液对于小肠梗阻手术指征的诊断灵敏度为100.00%,特异度为53.33%,约登指数为0.53,阳性预测值为64.10%,阴性预测值为100.00%;磁共振成像征象“C”形征与多腹腔间隙积液的灵敏度、特异度、阳性预测值、阴性预测值比较差异有统计学意义(P<0.05)。结论磁共振成像中“C”形征、腹腔积液征对小肠梗阻是否需要手术有很高的预估价值。Objective To evaluate the diagnostic value of"C"-shaped sign and multiple intra-abdominal space effusion on magnetic resonance imaging(MRI)for surgical indication of small bowel obstruction.Methods A retrospective analysis was conducted on magnetic resonance imaging of 55 patients with adhesive small intestinal obstruction,including 25 surgical patients and 30 non-surgical patients.Among the surgical patients,17 cases of intestinal obstruction were confirmed to be strangulated intestinal obstruction by surgery.For 30 nonsurgical patients,conservative treatment was used to improve the condition,and all cases were clinically diagnosed as adhesive intestinal obstruction.The magnetic resonance imaging features of small intestinal obstruction were analyzed.The diagnostic efficacy of the"C"-shaped sign of magnetic resonance imaging and multiple intraabdominal space effusion on whether surgery was needed for small bowel obstruction was analyzed.Results In 25 surgical patients,the obstruction duct dilated to different degrees,with an average of(3.90±0.73)cm,and multiple intra-abdominal space effusion such as pelvic cavity,paracolic sulci or intestinal space was observed in all patients.Among them,17 patients could see local curvature of the proximal obstruction dilated small intestine in a"C"shape,called the"C"-shaped sign.Intraoperatively,there was extensive dilatation and edema of the small intestine,necrosis and rigidity of the middle section of the obstructed intestine,and bloody ascites in the abdomen;pathological findings showed thickening of the intestinal wall in the middle segment of the obstruction,dark red bleeding on the mucosal surface of the small intestine,mucosal necrosis and shedding,edema and bleeding in the submucosa,attachment of exudates on part of the serous membrane,vascular congestion and bleeding.Magnetic resonance imaging showed that the diagnostic sensitivity of the"C"-shaped sign for whether surgery was needed for small bowel obstruction was 68.00%,and the specificity was 100.00%,the Youden's

关 键 词：小肠梗阻 磁共振成像 影像学诊断 手术指征 

分 类 号：R656.7[医药卫生—外科学] R445.2[医药卫生—临床医学]