继发性化脓性腹膜炎CT特征表现及其解剖、病理基础

CT Features and Anatomic-Pathologic Bases of Secondary Pyogenic Peritonitis

目的探讨继发性化脓性腹膜炎(secondarypyogenicperitonitis,SPP)的CT表现、显示率及其解剖、病理基础。方法回顾性分析24例SPP的CT表现特征,着重观察SPP在螺旋CT扫描中的基本CT表现和导致SPP的原发病灶及并发症的CT表现以及它们的显示率,并探讨其解剖、病理基础。结果24例SPP的主要CT表现如下:腹膜增厚16例(66.7%),其中光滑规则增厚14例,不规则增厚2例;腹腔积液15例(62.5%);腹腔游离气体9例(37.5%);大网膜和小肠系膜水肿、增厚分别为8例(33.3%)、5例(20.8%);肠壁水肿、增厚5例(20.8%);肠曲间相互粘连6例(25.0%)。导致SPP的原发病灶及并发症的CT表现:不同程度地显示出导致SPP原发病灶征象13例(54.2%),合并腹膜后间隙炎症13例(54.2%),胸部改变13例(54.2%),以及腹、盆腔脓肿6例(25.0%)。结论SPP的CT主要表现包括壁腹膜增厚,腹腔积液、积气,大网膜和小肠系膜水肿、增厚等;次要表现包括肠壁水肿、增厚,肠曲间相互粘连等。应用CT扫描诊断SPP,可显示较丰富的CT征象以协助诊断。

Objective To evaluate the main CT features, the morbidity of CT signs and the anatomie-patho logic bases of secondary pyogenic peritonitis （SPP）. Methods Twenty-four patients of the SPP were retrospectively studied. Emphasis wits placed on the spiral CT manifestations of the SPPcorrelating with their anatomic pathologic bases and the occurrence as well as the signs of primary lesions which resulted in the SPP. Results The main CT manifestations of SPP revealed as follows： the thickened peritoneum, 16 in 24 cases （66. 7%）, of which 14 cases were smooth and 2 cases were irregular： the ascites. 15 in 24 cases （62.5%）; the free air within peritoneal cavity, 9 in 2l cases （37. 5%）; the edema and thickening involved in the greater omentum, 8 in 24 cases （33. 3%）; the small bowel mesentery. 5 in 24 cases （20.8%）, and the bowels＇ wall. 5 in 24 cases （20. 8%）; the adhesions of bowcls, 6 in 24 cases （25.0%）. The CT manifestation of the promary lesions, which caused SPP, and the complications were shown as follows： the signs of primary lesion, 13 cases （54.2%）; the inflammatory changes in retroperhoneal cavity 13 cases （54.2%） ; the involvements of chest 13 cases （54.2%） ; and the abscess in peritoneal and pelvic cavity 6 cases （25. 0% ）. Conclusion The main significant CT signs of SPP could be concluded as follows： thickened peritoneum, ascites, free air within peritoneal cavity, edematous and thickened greater omentum, the small bowel mesentery, and the bowels＇ wall. as well as the adhesions of bowels. So. the CT scan can present plenty of CT signs, which are significant and very helpful for making an appropriate diagnosis of SPP.