MSCT对直肠癌术后肠梗阻的诊断价值及临床意义

Diagnostic value and clinical significance of MSCT in postoperative intestinal obstruction of rectal cancer patients

目的评价多层螺旋CT（multi-slice spiral computed tomography，MSCT）在直肠癌术后肠梗阻影像学诊断中的价值。方法搜集2011-2013年天津市人民医院1145例直肠癌开放术中50例肠梗阻患者的临床资料，回顾性分析患者的MSCT影像及临床表现，其中行腹会阴联合切除术（Miles）24例，低位前切除术（Dixon）18例，哈特曼术（Hartmann）8例。10例非手术治疗缓解，40例行手术治疗。采用x^2检验分析3种术式造成的肠梗阻的统计学差异。结果术后肠梗阻最常见的原因在Miles及Hartmann术后为肠粘连，在Dixon术后为吻合口狭窄。内疝及吻合口狭窄所致的肠梗阻在3种术式之间差异有统计学意义（X^2=5．382、20．486，均P〈0．05）。结论利用MSCT检查技术可进一步明确直肠癌术后肠梗阻的病因及梗阻部位，为临床制定治疗方案提供影像学依据。

Objective To evaluate the value of multi-slice spiral computed tomography （MSCT） in diagnosing postoperative intestinal obstruction of rectal cancer. Methods The CT imaging results and clinical manifestation of 50 patients with postoperative intestinal obstruction of rectal cancer confirmed by pathology were reviewed retrospectively. These cases including Miles （24 cases）, Dixon （18 cases）, Hartmann（8 cases） procedure were collected from Tianjin People＇s Hospital from 2011 to 2013. Conservative management was done in 10 cases and the remaining 40 patient underwent surgical intervention. Statistical difference between the three kinds of surgical causes of intestinal obstruction was analysed by X^2 test. Results Most common cause after Miles and Hartmann postoperative intestinal obstruction was of adhesion, while anastomotic stenosis was the most common reason of intestinal obstruction after Dixon procedure. The difference of incidence of intestinal obstruction caused by hernia and anastomotic stenosis between the three kinds of operation method was statistically significant （ X^2 = 5. 382,20. 486, P 〈 0.05 ）. Conclusions MSCT could identify the etiology and site of postoperative intestinal obstruction of rectal cancer, providing favorable imaging evidence for clinical treatment.