多层螺旋CT局限性小气泡征在消化道穿孔中的定位诊断价值

The Value of Extra Luminal Air Bubble Sign in Localization Diagnosis of Gastrointestinal Perforation Using MSCT

目的评价多层螺旋CT(MSCT)检查胃肠壁外局限性小气泡征(ELAB征)在消化道穿孔中的定位诊断价值。资料与方法回顾性分析2007-02～2010-10经手术证实的89例消化道穿孔患者的腹部CT图像。按照精确定位法[胃区,小肠(按Cole法分6组),结肠(分4组:盲肠、升结肠,横结肠,降结肠,乙状结肠、直肠)]及上、下消化道分组法,观察胃肠壁外局限性小气泡征与消化道穿孔部位的相关性。分析镰状韧带征、圆韧带征、肝门周围游离气体征(PPFA征)的敏感性、特异性及准确性。结果 89例消化道穿孔中85例出现游离气体,其中18例表现为胃肠壁外局限性小气泡积聚。18例具有ELAB征的穿孔患者脏器定位(按照精确定位法)与手术结果对照,准确性为94.4%(17/18)。镰状韧带征、圆韧带征、肝门周围游离气体征(PPFA征)在大体定位(上、下消化道分组法)中的准确性分别为74.2%(66/89)、68.5%(61/89)、84.3%(75/89)。结论多层螺旋CT胃肠壁外局限性小气泡征在消化道穿孔定位诊断中有重要价值。

Purpose To investigate the value of extra luminal air bubble sign （ELAB sign） in localization diagnosis of gastrointestinal perforation.Materials and Methods Retrospective analysis was performed in 89 patients surgically diagnosed as gastrointestinal perforation,and all had MSCT.Gastrointestinal perforation was precisely located as the gastric region,small intestine （6 groups defined by Cole method） and colon （4 groups including ascending colon;transverse colon;descending colon;sigmoid colon/rectum）,as well as upper digestive tract and lower digestive tract perforation.The correlation between the ELAB sign and gastrointestinal perforation was analyzed.The sensitivity,specificity and accuracy of falciform ligament sign,round ligament sign,periportal free air sign were investigated.Results 85 cases showed free gas and 18 cases showed ELAB sign among the 89 cases with gastrointestinal perforation.The accuracy was 94.4% （17/18） comparing with surgical findings using precise localization of gastrointestinal perforation.The accuracy was 74.2% （66/89） for falciform ligament sign,68.5% （61/89） for round ligament sign,84.3% （75/89） for periportal free air sign using upper and lower digestive tracts localization.Conclusion The MSCT ELAB sign has important clinical application value in localization diagnosis of gastrointestinal perforation.