多排螺旋CT对结核性腹膜炎与癌性腹膜炎的鉴别诊断

The Differential Diagnosis of MSCT in the Identification of Tuberculous Peritonitis and Cancerous Peritonitis

目的：探讨结核性腹膜炎（TBP）及癌性腹膜炎（CP）的多排螺旋CT（MSCT）表现,为两者的诊断及鉴别提供依据。方法：搜集2010年9月～2011年9月的24例TBP和47例CP患者的CT影像资料,全部病例经手术和病理进行确诊,采用χ2检验比较各种CT征象在两种病变中的发生率,结合病理变化、临床症状进行分析。结果：TBP组及CP组患者大量腹水,所占比例差异有统计学意义（41.7%、72.3%,χ2=9.695,P〈0.05）。TBP组以壁层腹膜均匀光滑增厚、肠系膜污垢样改变为主,CP组壁层腹膜以不规则、结节、块样增厚为主。结论：以壁层腹膜改变为基础,综合大网膜、肠系膜、腹水及淋巴结改变CT征象进行对两种病变的诊断及鉴别诊断具有重要意义。

Objective： To investigate the multi spiral computed tomography （MSCT） features of tuberculosis peritonitis （TBP） and carcinomatous peritonitis （CP） so as to improve the level of their diagnosis and differential diagnosis. Methods： Computed tomography imaging materials of 22 patients with tuberculous peritonitis and 45 patients with carcinomatous peritonitis confirmed by surgery and pathology between September 2010 and September 2011 were analyzed retrospectively. Chi-square test was applied to compare the incidence rates of various MSCT features in TBP and CP patient, and the results were compared again with pathological and clinical results. Results The incidences of large amount of ascites were significantly different between TBP group and CP group of patients （41.7%, 72.3%, Z2 = 6.343, P = 0.012）. The proportions of thickening parietal peritoneum and mesenterium cases were also statistically different among the two groups （P〈0.01）, however, the imaging findings of mesenteric nodes showed no significant difference between TBP group and CP group （P 〉 0.05）. In the TBP patients, the main manifestations were smooth thickening parietal peritoneum, and mottled soft-tissue densities in the mesenterium. In the CP patients, the main manifestations were nodular thickening of the parietal peritoneum. There was a statistical difference in the thickness of the greater momentum between the two groups of patients （P 〈 0.01）. Conclusions Based on the parietal peritoneum changes, comprehensive analysis of the greater momentum, mesenterium and ascites is helpful in and differential diagnosis of two diseases.