胆石性肠梗阻的影像对比分析

Comparative Analysis of the Radiological Findings in Gallstone Ileus

目的比较分析多层螺旋CT（Muti-slice Spiral CT，MSCT）、站立位腹部平片、上消化道造影对于胆石性肠梗阻的诊断价值。方法回顾性分析2011年～2013年确诊胆石性肠梗阻10例，均行腹部MSCT及站立位腹部平片检查，7例行上消化道造影检查。对比分析异位结石、肠梗阻、胆囊及胆道积气、胆肠内瘘的影像学表现。结果MSCT、腹部平片、上消化道造影对异位结石的检出率分别为：100％、20％、28．6％（2／7）；肠梗阻：90％、90％、100％（7／7）；胆囊及胆道积气：90％、10％、0。CT与上消化道造影对胆肠内瘘的显示分别为50％、100％（7／7）。结论对于胆石性肠梗阻的诊断，CT最有价值；上消化道造影对胆肠内瘘（胃及十二指肠瘘）的诊断有较高的价值；腹部平片的价值较低。

Objective To comparatively analyze the effectiveness of MSCT （Multi-Slice Spiral Computerized Tomography）, erect abdominal plain films and upper gastrointestinal imaging in diagnosis of gallstone ileus. Methods Retrospective analysis of 10 patients with confirmed gallstone ileus from 2011 to 2013 were made. Of the 10 cases, all underwent abdominal MSCT and erect abdominal plain films; 7 were examined with upper gastrointestinal imaging. Radiological findings of the allotriolith, intestinal obstruction, pneumatosis in the gallbladder and biliary tract as well as eholecysto-intestinal fistulas obtained by three imaging techniques were comparatively analyzed. Results The detection rates of the allotriolith, intestinal obstruction, pneumatosis in the gallbladder and biliary tract revealed by MSCT were 100%, 90%, 90% respectively versUs 20%, 90%, 10% by erect abdominal plain films .and 28.6% （2/7）, 100% （7/7）, 0 by upper gastrointestinal imaging. MSCT （50%） was inferior to the upper gastrointestinal imaging [100% （7/7）] in display of cholecysto-intestinal fistulas. Conclusion In comparison with other two imaging techniques, MSCT showed the greatest effectiveness in diagnosis of the gallstone ileus; the upper gastrointestinal imaging was of comparatively highest significance for detection of cholecysto-intestinal fistulas （Fistulas of Stomach and Duodenum）; the erect abdominal plain film was proven to be an imaging technique with the least effectiveness.