多层螺旋CT在小肠梗阻病因诊断中的初步应用

Preliminary application of multidetector spiral-CT in the diagnosis of small bowel obstruction

目的探讨多层螺旋CT三维成像技术在小肠梗阻中病因探讨的应用价值。方法12例高位肠梗阻患儿均行腹部CT检查，并选择在工作站进行多平面重建、容积重组技术、仿真内镜等图像三维处理以更好显示病变。影像学检查结果与最终手术诊断对照。结果12例患儿中，参照手术结果，4例空回肠闭锁，十二指肠闭锁、肠重复畸形、环状胰腺各2例，胎粪性小肠梗阻、肠旋转不良各1例。腹部CT检查正确发现十二指肠闭锁、肠重复畸形、环状胰腺各2例，1例肠旋转不良。腹部CT对于小肠梗阻的敏感性100％，特异性58％。结论（1）对先天性小肠梗阻，多层螺旋CT是消化道造影检查的良好补充技术，辅以三维重建技术，能更为直观地显示病变位置、范围、腔内外和周围组织情况。（2）多层螺旋CT操作简单、安全、无痛苦，但其扫描前准备值得临床进一步研究。

Objective To explore the value of multidetector spiral-CT （MSCT） in etiological diagnosis of small bowel obstruction. Methods We reviewed the records of MSCT diagnoses of 12 children with the new software such as multiplanar reformation （MFR）, Volume-rendered image （VR）, Virtual endoscopy. The pathological diagnosis made by surgical inspection served as golden standard. Results Of the 12 patients＇ surgical results, jejunoileum atresia were found in 4 patients, duodenum atresia, annular pancreas and duplication of intestine in 2 patients respectively, meconium ileus and malrotation of intestine in 1 patient respectively. MSCT correctly identified duodenal atresia, intestinal duplication and annular pancreas in two cases respectively, as well as intestinal malrotation in 1 case. The sensitivity and specificity of MSCT diagnosis were 100 % and 58 % respectively. Conclusion （1） Multidetector spiral-CT is a good supplementary method of intestinal contrast examination for newborn with small bowel obstruction. It can directly define the place, site, and tissue around the bowel lumen 9f the disease when three dimensional reconstruction technology is apllied. （2） Multidetector spiral-CT is a simple, safe and noninvasive diagnostic method. But its preparation before scan still needs further clinical research.