多层螺旋CT在胃肠道破裂穿孔中的应用

Application of multi-slice spiral CT in the diagnosis of perforation of gastrointestinal tract

目的探讨胃肠道破裂穿孔的MSCT表现及诊断价值。方法收集25例经手术证实为胃肠道破裂穿孔患者的临床及MSCT资料,回顾性总结了胃肠道破裂穿孔的MSCT表现。结果25例破裂穿孔中胃2例,十二指肠球部5例,十二指肠降段1例,空肠6例,回肠7例,盲肠1例,横结肠2例,乙状结肠1例。MSCT表现有腹腔游离气体、肠壁周围局限性积气、腹腔积液、肠壁增厚、肠腔周围脂肪间隙密度增高(“条纹征”),其中4例直观地显示破口,1例造影剂外溢。结论MSCT有利于显示胃肠道穿孔部位及其管壁周围的变化情况,可为临床提供更多有价值的诊断信息,但敏感性和特异性有待提高。

Objective To evaluate the application of multi-slice spiral CT （MSCT） in the diagnosis of perforation of gastrointestinal tract. Methods Clinical data and MSCT imaging of 25 patients with perforation of gastrointestinal tract proved by surgery were collected and analyzed retrospectively. Results Of all 25 perforations, 2 were in the stomach, 5 in the duodenum, 1 in the capitulate duodenum, 6 in the jejunum, 7 in the ileum, 1 in the appendix, 2 in the transverse colon, 1 in the sigmoid flexure. The MSCT findings had pneumoperitoneum （n= 20）, peritoneal effusion （n= 11）, bowel wall thickening （n=17）, inflammatory changes in peri-gastrointestinal soft tissues /＂striation sign＂ （n= 19）, and the visualization of discontinuity of the bowel wall （n= 4）, extravasation of contrast media （n = 1）. Conclusion MSCT can clearly indicated the site of perforation, changes of peri-gastrointestinal tract in the perforation of gastrointestinal tract, and provide much useful information to surgeons, but the sensitivity and specificity of MSCT need to be improved.