多层螺旋CT后重建技术在诊断小肠肠梗阻中的应用价值

The Value of Reconstruction with Multislice CT in the Diagnosis of Small Intestinal Obstruction

目的:探讨多层螺旋CT后重建技术在诊断小肠不全性肠梗阻中的应用价值。方法:搜集64例经手术治疗及随访观察明确诊断为肠梗阻的患者。观察肠系膜血管聚集、拉伸、牵拉、扭曲,小肠狭窄及扩张程度,并进行统计学处理。结果:(1)MPR显示:肠道肿块18例,肠道浸润性狭窄6例,肠道炎性狭窄23例,肠套叠9例,漩涡征11例。显示肠系膜上动脉钙化斑块9例,非钙化斑块6例。肠壁增厚35例,肠壁呈环形强化20例,肠壁内点状积气5例,肠系膜水肿8例,肠系膜静脉内积气1例,肠壁无强化5例。腹腔积液13例。(2)CTA显示:肠系膜上动脉旋转11例,肠系膜上动脉移位45例,肠系膜血管聚集15例,肠系膜血管分散18例,肠系膜上动脉闭塞14例。结论:利用128层螺旋CT扫描,联合血管容积再现(VR)及多平面重建(MPR)后重建技术,可以早期确定梗阻的具体部位、梗阻的原因;客观地分析判断病变肠管缺血程度。

Objective ：To evaluate the reconstruction with multislice CT in diagnosis of the partial ileus .Methods ：64 cases of the intestinal obstruction confirmed by surgery or follow-up were collected to observe the gathering of mesenteric vessels, stretching, distorting, and stenosis or expansion of small intestinal, which were dealt with statistics .Results ：（1）Multiplanar reconstruction （MPR）findings：masses about intestine in 18 cases, lumen stenosis of infiltrating in 6 cases, lumen stenosis of inflammation in 6 cases, intussusception in 9 cases, whirl sign in 11 cases, calcific plaques of superior mesenteric artery in 9 cases, non-calcified plaques in 6 cases, thickening of intestines wall in 35 cases, annular enhancement of the bowed wall in 20 cases, point pneumatosis of intestines wall in 5 cases, edematous mesentery in 8 cases, pneumatosis of mesenteric venous in 1 case, intestines wall with no enhancement in 5 cases and hydrops abdominis in 13 cases .（2）Computed tomography angiography （CTA） fingings ：rotational superior mesenteric artery in 11 cases, displacement in 45 cases, gathering of mesenteric vessel in 15 cases, scattering of mesenteric vessel in 18 cases sand superior mesenteric artery embolism in 14 cases .Conclusion：The site and the cause of obstruction can be identified early by128-slice CT combined with volume rendering（VR） and MPR which can also objectively analyse the degree of bowel ischemia.