多层螺旋CT诊断急性肠梗阻患者的临床价值

Clinical value of multislice spiral CT diagnosis of patients with acute intestinal obstruction

目的探讨多层螺旋CT在急性肠梗阻诊断中的价值。方法回顾性分析上海市江湾医院2008年2月至2012年2月收治的经手术和病理证实的60例急性肠梗阻患者多层螺旋CT表现。结果 60例肠梗阻患者中,肠肿瘤23例,肠黏连14例,腹内外疝12例,肠套叠4例,肠扭转2例,阑尾周围脓肿3例,胆石1例,肠系膜静脉血栓1例。CT扫描显示梗阻点位于小肠32例,结肠28例表现为梗阻近端肠腔扩张,而远端肠腔萎陷;扩张的肠腔内可见气液平,梗阻部位可见"移行段"。靶征、鸟嘴征、漩涡征等具有诊断价值。增强扫描后梗阻段肠壁异常强化。结论多层螺旋CT可判断有无急性肠梗阻、梗阻部位、梗阻病因以及是否绞窄,是诊断急性肠梗阻的有效方法之一。

Objective To ＂investigate the clinical value of multislice spiral CT diagnosis for patients with acute intestinal obstruction. Methods The muhislice spiral CT signs of 60 patients with acute intestinal obstruction proved by surgery and pathology in the Jiangwan Hospital from February 2008 to February 2012 were analyzed retrospectively. Results Sixty patients with intestinal obstruction included 23 cases of intestinal tumors, 14 cases of intestinal adhesion, 12 cases of intra-abdominal and external hernia, 4 cases of intussusception, 2 cases of volvulus, 3 cases of periappendicular abscess, 1 case of gallstone and 1 case of mesenteric venous thrombosis. CT scan showed that 32 patients＇s obstruction point located in the samll bowel, 28 cases of colon presented as expanding intestinal cavity at proximal obstruction and collapsed intestinal cavity at the distal obstruction. Gas-fluid levels may be seen in the expanding lumen, and the ＂transitional segment＂ may be seen in the obstructive position. Target sign, beak sign and whirl sign had diagnostic value. The intestinal wall of obstruction had abnormal enhancement after CT enhancement scan. Conclusions Multislice spiral CT can judge the presence of acute intestinal obstruction, the site of obstruction, the cause of obstruction, and the obstruction whether strangulated or not, which is one of the effective methods to diagnose acute intestinal obstruction.