妇科腹腔镜术后并发症的多层螺旋CT检查

Multi-slice spiral CT examination on complications after gynecologic laparoscopic surgery

目的探讨多层螺旋CT对妇科腹腔镜术后并发症的诊断价值。方法回顾分析经转开腹手术或临床保守治疗后CT或IVP等复查随访等方法证实的妇科腹腔镜手术后并发症19例。结果输尿管中下段和(或)膀胱后壁多发鼠咬状缺损、或输尿管下端中断、膀胱后壁破损形成尿漏共13例;乙状结肠、空、回肠壁肿胀、缺损、局部肿胀增厚或破口,并见肠周围脂肪间隙模糊、积液和前腹壁或肝缘散在分布气泡影或弧线透亮影3例;腹腔镜构件遗留物1例;单侧或双侧膈下等、高密度新月形或线状影等膈下积血8例;子宫旁等、高密度血肿1例;19例均合并腹腔积液;部分病例上述征象合并存在。结论多层螺旋CT是妇科腹腔镜术后并发症的重要检查手段。其中图像后处理技术的三维容积再现(VR)和最大密度投影(MIP)图像对泌尿系损伤和异物的诊断、多平面重组(MPR)图像对肠破裂的诊断分别具有优势。

Objective To investigate the diagnostic value of multi-slice spiral CT on complications after gynecologic laparoscopic surgery.Methods To review and analyze 19 cases of complications confirmed by follow-up re-examination such as CT or IVP when converting to laparotomy or clinical conservative treatment.Results 13 cases with rat-bite-like defects in lower section of ureter and（or） the posterior wall of the bladder,or urine leakage caused by lower ureteral disruption and damaged posterior wall of bladder;in 3 cases that the wall of sigmoid colon,jejunum and ileum has swelling,defect,local thickening or rupture,the space between intestinal fat is vague,fluid and anterior abdominal wall or liver margin is scattered,showing bubble shadows or translucent shadows;remnant of laparoscopic component is found in 1 case;8 cases with high-density crescent-shaped or linear opacities of subphrenic hematoma in unilateral or bilateral diaphragm etc;high-density hematoma beside uterus etc is found in 1 case;all the 19 cases are complicated with ascites;some cases are complicated with all the above-mentioned signs.Conclusion Multi-slice spiral CT is an important examination means for complications after laparoscopic surgery.The postprocessing techniques,such as three-dimensional volume rendering（VR） and maximum intensity projection（MIP）,have an edge on diagnosing injury and foreign matter in urinary system,the multi-planar reformation（MPR） image has an anadvantage on the diagnosis of intestinal rupture.