CT肠壁积气征在评估肠管血运活性上的意义

Value of pneumatosis intestinalis on CT for predicting the viability of bowel

目的评估CT肠壁积气征对判断透壁性肠坏死或部分性肠缺血的意义。方法通过对38例临床有肠缺血表现和/或有肠缺血高危因素病例的CT征象分析,并与临床及手术病理结果对照,比较无活性肠管组与有活性肠管组之间CT征象的差异,重点对照分析CT肠壁积气征与手术、病理结果之间的关系。结果肠壁积气征、门脉积气征及腹腔游离气体征的发生率无活性肠管组明显高于有活性肠管组,两组间存在显著性差异。CT肠壁积气征,尤其合并有门静脉系统积气征象时,与肠壁全层透壁性坏死高度相关。单个"气泡"型肠壁积气征多为部分性肠缺血。结论在肠缺血病例中,CT肠壁气肿征并不一定提示肠壁已发生透壁性肠坏死。合并有门静脉积气及肠壁积气的病例较单纯肠壁积气的病例,发生透壁性肠坏死的可能性更大。

Objective To investigate the value of CT finding of pneumatosis in the diagnosis of intestinal transmural necrosis versus partial mural ischemia. Methods CT of 38 patients with clinical presentation or risk of ischemic bowel disease was reviewed and correlated with the clinical and pathologic information. Results Pneumatosis intestinalis, porto- mesenteric venous gas and pneumoperitoneum were more often found on CT of patients with irreversible transmural bowel infarction than those with partial mural ischemia. Patients with pneumatosis and porto-mesenteric venous gas were more likely to have transmural infarction than those with pneumatosis alone： Two patients with pneumatosis in the thicken ileal wall had partial mural ischemia with viable bowel. Conclusion In intestinal ischemia, the CT finding of pneumatosis does not always indicate transmural infarction of the bowel. Patients with associated porto-mesenteric venous gas are more likely to have transmural infarction than those with pneumatosis alone.