16层CT轴位结合矢状位重建在胃肠穿孔腹腔积气积液分布诊断中的价值

16-Slice CT Findings of the Distribution of Intraperitoneal Free Gas and Fluid in Gastrointestinal Perforation

【目的】探讨16层CT轴位结合矢状位重建对胃肠穿孔所致腹腔内游离气体、积液分布的诊断价值。【方法】收集48例手术证实胃肠穿孔病例的16层CT扫描影像资料作回顾性分析。【结果】上腹部膈下少量积气28例（占58％）：CT轴位表现为剑突下、右肝上间隙小气泡状或线状、新月形气影，胃窦周围蜂窝织炎，矢状位重建示前腹膜腔线状或新月形气影；腹腔膈下广泛积气、积液20例（占42％）：CT轴位显示肝周液气平面15例、肝脾周围均见液气平面5例，伴有小网膜囊积液、气泡3例，肠壁周围积液、小气泡5例，右半结肠管腔扩张壁增厚6例，大网膜脂肪密度增高3例，矢状位重建示前腹膜腔新月形7例，积气积液形成液气平面13例；根据穿孔处渗出及管壁轮郭改变术后正确诊断穿孔部位36例，正确率为75％。【结论】16层CT轴位结合矢状位重建能显示腹腔少量游离气体的分布，对胃肠穿孔具有良好的诊断价值并可判断病情的严重程度。

[Objective] To explore the diagnostic value of axial and sagittal reconstruction of 16 slice CT for in- traperitoneal free gas and fluid distribution caused by gastrointestinal perforation. [Methods]The data of 16 slice CT scanning of 48 patients with gastrointestinal perforation confirmed by surgery were collected and analyzed retrospec- tively. [Results] Small amount of gas accumulation in inferior phren of upper abdomen was found in 28 patients （58% ）. Axial CT findings showed small air bubble-like, linear or luniform gas shadow under xiphoid and in right su- prahepatic space and cellulites around gastric antrum. Sagittal reconstruction revealed linear or luniform gas shadow in anterior peritoneal cavity. Extensive gas and fluid accumulation under xiphoid of abdominal cavity was found in 20 pa- tients（42%）. Axial CT findings showed fluid gas plane around liver in 15 patients, fluid-gas plane around liver and spleen in 5 patients, gas and fluid accumulation in small omental sac in 3 patients, fluid and small gas bubble around intestinal wall in 5 patients, lumen expanding and wall thickening of right hemicolon in 6 patients and fat dense of o- mentum majus in 3 patients. Sagittal reconstruction revealed luniform gas shadow in anterior peritoneal cavity in 7 pa- tients and fluid-gas plane formation in 13 patients. According to the effusion at perforation and the change of wall out- line, the perforation position was assessed in 36 patients after operation correctly, and the accurate rate was 75%. [Conclusion] Axial and sagittal reconstruction of 16-slice CT can reveal the distribution of small amount of free gas in peritoneal cavity, and has good value in the diagnosis of gastrointestinal perforation and the evaluation of the severity of the disease.