胃肠道穿孔腹部平片和多层螺旋CT诊断比较研究

Comparative Study of Plain Abdominal Radiograph and Multiple Detector CT in Gastrointestinal Tract Perforation

目的对比研究多层螺旋CT和腹部平片对胃肠道穿孔的临床诊断价值。方法回顾性分析69例经病理证实的胃肠道穿孔患者的CT及腹部平片表现,其中行腹部CT检查者69例,行腹部平片检查者43例。结果腹部平片和CT显示腹腔积气阳性率分别为81.4%(35/43例)、95.6%(66/69例),差异有统计学意义(P<0.05)。CT显示胃肠道穿孔其他主要征象的阳性率分别为:胃肠道壁的连续性中断15.9%、腹腔积液84.0%、穿孔肠道周围脂肪间隙模糊81.1%、小气泡72.4%,小气泡提示穿孔部位的准确率为92%(46/50)。CT诊断胃肠道穿孔部位的准确率为89.8%(62/69),对相关病因诊断准确率为79.7%(55/69)。结论相比腹部平片,多层螺旋CT对胃肠道穿孔有更重要的临床诊断价值。

Objective To compare the clinical value of CT and plain abdominal radiograph in the diagnosis of gastroin testinal tract perforation. Methods The MDCT and abdominal radiography manifestation of 69 cases with gastrointestinal perforation confirmed by histopathology were retrospectively analyzed, including abdominal CT in 69 cases and abdominal ra diography in 43 cases. Results The positive rate of aeroperitoneum examined by X ray film and CT was 81.4% （35/43 cases） and 95.6% （66/69）respectively （P 〈 0. 05 ）. The positive rate of the other major CT findings were as follows： the defect of the gastrointestinal wall（ 15.9% ）, ascites（84% ）, the fuzzy fat gap adjacent to the gastrointestinal tract perfora tion （81.1% ） , the ＂bubble＂ sign （72.4%）. The accurate rate of the ＂bubble＂ sign in predicating the location of gastroin testinal tract perforation was 92% （46/50）. CT images correlated with the site of gastrointestinal tract perforation was in 62 （89.8%） of 69 patients. The diagnostic value of CT for the causes of gastrointestinal tract perforation was 79.7% （55/ 69）. Conclusion Compared with plain abdominal radiograph, multislice spiral CT has more significant clinical value in the diagnosis of gastrointestinal tract perforation.