小儿肠梗阻的腹部X线平片和CT诊断价值分析

Children's Small Bowel Obstruction: Valuate Plain Abdominal Radiography and Computed Tomography Diagnosis

目的:分析腹部X线平片和CT对小儿肠梗阻的诊断价值,重点探讨小儿绞窄性肠梗阻的CT表现。材料和方法:收集2002年1月-2004年6月复旦大学附属儿科医院手术证实肠梗阻23例,术前24h均拍摄腹部正侧位X线平片,其中14例行腹部CT扫描。结果:23例肠梗阻术前诊断正确率:腹部X线平片为69.6%(16/23);CT为100%(14/14)。其中,绞窄性肠梗阻术前诊断正确率:腹部X线平片为38.9%(7/18);CT为90.9%(10/11)。11例绞窄性肠梗阻的主要CT表现包括:小肠壁增厚9例;CT平扫肠壁密度增高7例和“靶征”2例;CT增强扫描肠壁强化低于正常者6例,3例延迟扫描强化。肠系膜血管增粗水肿5例,小肠壁积气4例,腹水6例。结论:CT诊断小儿肠梗阻,特别是显示肠绞窄,较腹部X线平片优越。

Purpose： To evaluate the Value of plain abdominal radiography and computed tomography （CT） in diagnosis of children small bowel obstruction, and to discuss the CT features for the diagnosis of intestinal strangulation. Materials and Methods： 23 children with surgically proven small bowel obstruction were retrospectively reviewed. All of them underwent plain abdominal radiography and 14 cases underwent CT. Results： Among 23 small bowel obstruction, 16 （69.6 96） cases with plain abdominal radiography were diagnosed, all of 14 cases with CT were diagnosed. In the strangulation group the positive abdominal radiography was 38.9 96 （7/ 18）, but CT was 90.9 96 （10/ 11） . The CT finding of intestinal strangulation included the following： bowel wall thickening （9/11） and higher density （7/11）; target sign （2/11）; reduced bowel wall enhancement （6/11） and delayed enhancement （3/11）; mesenteric vessel engorgement （5/11）; pneumatosis intestinalis （4/11）; ascites （6/11）; pneumoperitoneum （1/11）. Conclusion.CT was superior to plain abdominal radiography in diagnosing of intestinal obstruction and verifying the intestinal strangulation.