胆石性肠梗阻的CT诊断

CT Diagnosis of Gallstone Ileus

目的 探讨CT对胆石性肠梗阻的诊断价值。资料与方法 回顾性分析8例经手术证实的胆石性肠梗 阻患者的CT检查资料。所有病例均有胆囊结石、胆囊炎病史1-10年,并经B超和临床证实,其中5例有明确胆囊 炎反复发作病史。发病时患者出现持续性中上腹痛,腹胀,恶心,呕吐,3例患者出现停止肛门排气排便典型肠梗阻 症状,5例患者表现为不全性肠梗阻症状。结果 所有病例CT图像上均可见胆囊窝结构紊乱,邻近胃窦或十二指 肠降段壁增厚,胆囊空虚,胆囊及肝内胆管积气。1例胆石位于十二指肠降段;4例结石位于空肠段,其中2例结石 位于屈氏韧带处;另3例结石位于回肠末段。结石呈圆形或椭圆形,直径2．7-5．0 cm,梗阻以上肠管扩张,积气积 液明显,可见液平面。3例完全性梗阻病例梗阻以下肠管空虚,5例不全梗阻病例梗阻以下肠管内仍可见少量气体 及液体,结肠内可见粪便气体混合影。8例均在术前经CT得到正确诊断,准确率为100％。结论 CT对胆石性肠 梗阻的诊断准确性高。凡65岁以上老年人出现间歇性不完全性机械性肠梗阻,特别是既往有胆道病史而无腹部 手术史者,应考虑胆石性肠梗阻的可能,应行CT检查明确诊断。

Objective To evaluate the clinical application of CT in the diagnosis of gallstone ileus. Materials and Methods 8 patients of gallstone ileus obstruction confirmed by surgical findings, who had CT scans and clinical data, were retrospectively reviewed. All cases had history of gallbladder calculus and chronic cholecystitis for 1 - 10 years, in which 5 cases had a history of cholecystitis outbreak. The symptoms included middle and upper abdomen pain continuously, abdomen bulge, nausea, vomiting. 3 cases had symptoms of ileus and 5 cases of incomplete ileus. Results The follow findings were searched on with all cases： Gallbladder region turbulence, gastric wall and duodenum wall thickening, pneumobilia, air in gallbladder, cholecystodigestive fistula. The ectopie stones were wedged in the descendant portion of duodenum （n = 1）, jejunum （n = 4）, Treitz ligment region （ n = 2） and ileum （ n = 3） . The calculus were round or oval and diameters were from 2.7cm to 5.0cm. Bowel loops dilatation, extraluminal fluid, intestinal alr-fluid levels and could be seen above the obstruction location. The diagnostic rate of CT preoperatively to gallstone ileus was 100%. Conclusion The abdomen CT scan is accurate for diagnosing the gallstone ileus, which is helpful for diagnosing the suspected cases who are more than 65 years old with intermittence incomplete mechanic obstruction and with the history of bile duct diseases.