螺旋CT在胃肠道穿孔中的诊断价值

Value of Spiral CT in the Diagnosis of Gastrointestinal Tract Perforation

目的:评价胃肠道穿孔的螺旋CT诊断价值。方法:33例经手术证实的胃肠道穿孔患者中,术前行腹部平片检查者28例,腹部CT扫描者33例。回顾性分析其CT表现,比较两种检查方法的诊断结果。结果:本组中X线平片和CT显示腹内游离气体的阳性率分别为71.4%(20/28例)和90.9%(30/33例),差异有显著性意义(P<0.05)。CT显示腹内游离气体呈新月状或小气泡影(n=30),胃肠穿孔处周围局限性积液或蜂窝组织炎(n=21),阑尾周围脓肿(n=4),肠梗阻(n=8),胃肠壁增厚(n=16),胃肠壁肿块(n=2),少量腹水(n=5)。术前CT对胃肠道穿孔病因诊断的符合率为87.9%(29/33)。结论:螺旋CT对诊断胃肠道穿孔及其病因和并发症有明显优势。

Objective.. To evaluate the value of spiral CT in the diagnosis of digestive tract perforation. Methods：33 cases with digestive tract perforation proved by surgery were analyzed. All of these cases were examined by abdominal CT and 28 cases had abdominal X-ray film preoperatively. Results.. The causes of digestive tract perforation in this study were mainly inflammation, ulcer,tumor and trauma. The positive rate of demonstrating free air within abdominal cavity examined by X- ray film and CT were 71.4% （20/28） and 90.9% （30/33） respectively （P〈0.05）. The direct CT sign of digestive tract perforation was ＂crescent＂ or ＂bubble＂ sign formed by the air within peritoneal cavity and retroperitoneal space, which were detected in 30 cases. The other findings were showing localized fluid or cellulites adjacent to the gastrointestinal tract perforation （n= 21） and appendiceal abscess （n= 4）. 8 cases associated with bowel obstruction, 16 cases with gastrointestinal wall thickening,2 cases with gastrointestinal mass and 5 cases with ascites. The preoperative diagnostic accuracy of CT for the causes related with digestive tract perforation was 87.9%（29/33）. Conclusion： This study indicates that spiral CT has more advantages in the diagnosis of digestive tract perforation.