多层螺旋CT在胃肠道穿孔诊断中的应用

Application of Multi-slice Spiral CT in the Diagnosis of Gastrointestinal Perforation

目的探讨胃肠道穿孔的多层螺旋CT(MSCT)表现及诊断价值。方法收集2010年3月-2011年3月18例经手术证实为胃肠道穿孔患者的临床及MSCT资料,回顾性分析了胃肠道穿孔及穿孔部位的MSCT表现。结果 18例患者中,MSCT明确诊断穿孔17例,对穿孔部位准确定位11例。其中术后诊断胃穿孔4例、十二指肠球部穿孔9例、小肠穿孔3例、结肠穿孔1例、阑尾穿孔1例。MSCT表现有腹腔游离气体,肠壁周围局限性积气、腹腔积液及肠袢积液、肠壁增厚、肠腔周围脂肪间隙密度增高(条纹征)。结论 MS CT有利于显示腹腔游离气体、胃肠道穿孔部位及其肠壁周围的变化情况,对胃肠道穿孔术前的定性及定位诊断有较明显的优势,可为临床提供更多有价值的诊断信息。

Objective To explore the manifestations and value of multi-slice spiral CT （MSCT） in the diagnosis of gastrointestinal perforation. Methods We Collected the clinical and MSCT data of 18 patients confirmed by surgery to have gastrointestinal perforation between March 2010 and March 2011 and retrospectively analyzed the MSCT manifestations of their gastrointestinal perforation and perforation site. Results Of the 18 patients, MSCT clearly diagnosed perforation in 16 patients, and accurately located the perforation sites in 11 patients. Postoperative diagnosis confirmed four cases of gastric perforation, nine of duodenal perforation, two of intestinal perforation, one of colonic perforation, and another 2 of perforated appendix. The MSCT manifestations included free intraperitoneal gas, gas around the bowel wall, ascites and bowel loops effusion, bowel wall thickening, and higher density of intestinal fat gap （Stripes）. Conclusion MSCT is helpful in manifesting free intraperitoneal gas, gastrointestinal perforation sites and bowel wall changes, and has an advantage in qualifying and locating diagnosis of gastrointestinal perforation before surgery, which can provide more valuable clinical diagnostic information.