结肠癌性肠梗阻的CT表现

CT findings of the colon-carcinous obstruction

目的确定肠梗阻的部位与病因,并讨论结肠癌的CT表现与检查方法。方法26例临床疑诊结肠癌患者包括手术病理证实的23例结肠癌和3例回盲区炎症术前均经全腹CT平扫,21例又经增强扫描,8例经多平面重建(MPR)检查。结果CT检查证实,结肠癌性肠梗阻表现为梗阻近端肠管扩张,梗阻远端肠管空虚,移行段(病变段)肠管不规则软组织肿块,肠壁增厚,肠腔不规则狭窄,局限性强化。典型者病变段肠管长轴切面可见类结肠造影表现:不规则狭窄肠管与正常肠管分界清楚,呈"肩样征"。26例中,术前3例结肠癌被漏诊,3例回盲区炎症被误诊为结肠癌,CT诊断结肠癌性梗阻的敏感性为87%,准确性为76%。结论全腹CT扫描,尤其MPR对判定结肠癌性梗阻部位与病因有较高的敏感性,并有助于术前临床分期。

Objective To determine the location and etiology of bowel obstruction and to discuss the CT findings and detective modalities of the colonic carcinoma.Methods Twenty-six patients with clinically suspected colonic carcinoma,who comprised 23 colonic carcinomas and 3 ileocecal inflammations confirmed by surgery and pathology underwent CT plain scans of the whole abdomen,21 patients underwent enhanced CT scans,8 patients underwent muhiplanar reconstruction （MPR）examinations before the operation.Resutis CT scanning demonstrated that,colon-carcinous obstruction presented proximal segment dilatation and distal segment cavitation of the obstruent bowel ducts,irregular soft tissue masses of the affected segments,thickened bowel walls,irregular narrowing bowel cavities,and localized enhancement.Typical patient on whose longitudinal axial section of the affected segment could find to have the findings similar to colonic photography,i.e.the demarcation between irregular narrowing and normal bowel ducts was clear, which appeared as shoulder form sign.Among 26 cases,3 cases of colonic carcinoma were preoperatively leak-diagnosed,while other 3 cases of ileacecal inflammation were misdiagnosed as colonic carcinoma.The sensitivity and accuracy of CT for diagnosing colon-carcinous obstruction were 87% and 76%,respectively. Conclusion CT scanning of the whole abdomen,especially MPR has higher sensitivity for identifying the location and etiology of colon-carcinous obstruction and it is helpful to perform preoperatively clinical staging.