绞窄性肠梗阻肠系膜及其血管改变的CT研究

CT studies of mesentery and related vascular findings in strangulating intestinal obstruction

目的对经CT检查、有肠系膜及其血管(MRV)改变的30例绞窄性肠梗阻(SO)进行分析,探讨CT诊断的临床价值。方法30例SO,均行CT平扫,其中20例行增强扫描,均显示有不同形式的MRV改变。26例经手术、4例经临床证实,包括粘连性肠梗阻9例,肠扭转8例,肠套叠6例,肠系膜血管闭塞性肠梗阻4例,内疝3例。结果所有病例经CT检查可发现11种CT征象,并可分作:(1)直接征象:包括肠系膜血管闭塞2例,肠系膜水肿及其血管增粗并形态异常19例;(2)间接征象:包括肠壁水肿增厚24例,CT强化肠壁异常6例,肠腔大量积液13例,肠袢特殊形态10例,肠壁、肠系膜出血各1例;(3)并发症征象:包括肠壁间积气3例,肠系膜门脉积气1例,肠系膜积气1例,腹水和气腹共11例。结论急腹症CT检查如能显示MRV改变,结合其他CT征象和临床,可以对SO术前作出诊断。同时也能观察到传统X线不能显示的并发症。

Objective To investigate the CT appearance of mesentery and related vascular （MRV） findings in strangulating obstruction （ SO ） and evaluate the value of CT examination for diagnosing SO. Methods Thirty patients with SO were included in the investigation. The diagnosis was confirmed by operation in 26 cases and 4 cases by clinic. The cause of SO included adhesion in 9 cases, volvulus in 8 cases, intussusception in 6 cases, infarction of mesenteric vesseles in 4 cases, and internal hernia in 3 cases, respectively. All patients was examined with CT and 20 of them with enhanced CT. Results Eleven items of CT findings were revealed in these patients. The findings could be divided into 3 types： （ 1 ）direct signs： including embolism of mesenteric vasculature in 2 cases and mesenteric edema and related vascular enlargement in 19 cases. （2） indirect signs： including bowel wall edema and thickenning in 24 cases, abnormal enhancement of the wall in 6 cases, massive fluid in the bowel in 13 cases, abnormal form of loops in 10 cases, and hemorrhage of bowel wall and mesentery in 1 case each. （3）complicated signs： including intramural gas in 3 cases, intrahepatic portal veins gas in 1 case, gas in mesentery in 1 case, and ascites and pneumoperitoneum in 11 cases. Conclusion The CT findings of mesenteric edema, ischemia and infarction are reliable and characteristic signs for diagnosing SO. The diagnosis of SO can be correctly made before operation if these signs are recognized, at the same time, CT may demonstrate some complications which can not be revealed by traditional X-ray examinations.