术后肠粘连气腹造影的螺旋CT影像特征及其临床价值

Pneumo-peritoneum helico-CT imaging in post-operative peritoneal adhesion

目的:探讨成人术后肠粘连(postoperative peritoneal adhesion,POPA)气腹造影的螺旋CT影像(pneumoperitoneum helico-CT imaging,PHCT)特征及其临床价值。方法:术后慢性腹痛或有机械性肠梗阻反复发作的疑为术后肠粘连患者32例,采用腹腔穿刺置管注气造影后CT扫描,同时完成腹腔镜手术。对照手术所见对气腹造影影像特征进行解析判读,判定PHCT的临床应用价值。结果:2例(2/32,6.25%)患者表现为正常气腹腹腔CT图像,腹壁圆膨,腹内脏器呈平面铺展,其间为穹窿状的气腹空间,腹腔镜检查未发现粘连及其他病变。30例(30/32,93.75%)患者表现为局限性的腹壁粘连的影像特征,腹腔内脏器局部隆起,跨越气腹空间与腹壁贴附。粘连的脏器小肠、网膜最多见,另有肝脏、胃壁、横结肠和子宫。同时完成腹腔镜腹内粘连松解术,粘连的脏器组成、分布和形态的镜检结果与气腹造影影像相符。结论:PHCT检查安全、简便易行,对腹壁粘连可达到镜像显示的效果,能较全面地揭示腹部术后腹壁粘连的概况和特征。PHCT可作为腹腔镜检的替代手段,成为POPA临床诊断的基本方法,对手术的实施有指导性作用。

Objective To discuss the diagnostic value of pneumoperitoneum helico-CT imaging（PHCT） in cases of post-operative peritoneal adhesion（POPA）.Methods We retrospectively analyzed the PHCT scan pictures from 32 consecutive patients with chronic abdominal pain or recurrent mechanical intestinal obstruction after abdominal operation.Results In a normal peritoneal cavity without adhesion,an air distended dome-like space would be demonstrated with the abdominal organs arranged smoothly on the bottom of the shadow.Any additional shadow appearing in the dome-space would suggest adhesion or something abnormal.Positive findings of peritoneal adhesion were found in 30 of the 32 patients（93.75%）.A spot adhesion at the abdominal wall making a kinking of intestine usually showed a cuneiform bulging shadow pointed to the roof of the dome-space.Organs involved in the adhesion may be single or multiple,including the liver,stomach,small intestine,colon,uterus,and omentum.In all the 32 patients,PHCT diagnosis was confirmed by the subsequent laparoscopy treatment.Conclusion PHCT imaging is valuable in making a definite diagnosis of POPA,particularly before a blind laparoscopic exploration.It is a replacement for laparoscopy but much simpler,and may offer a valuable help in dealing with the difficult cases of suspected POPA.A negative imaging is sometimes very important to an undetermined postoperative chronic abdominal pain.