粪石性小肠梗阻临床与MSCT表现对诊断的价值

A bezoar-induced small bowel obstruction: to evaluate role of clinical and MSCT features in diagnosis

目的 分析粪石性小肠梗阻临床和多层螺旋CT（MSCT）影像的特征,探讨及时有效的诊断措施。方法 回顾分析2000—2013年手术证实粪石性小肠梗阻36例的临床和MSCT资料。结果 36例中男∶女=1∶2;农村∶城镇居民=4∶1;28例（78%）年龄〉60岁。发病时间为10月至次年3月。均无上消化道手术史。临床表现腹痛29例（81%）;呕吐25例（69%）;腹胀19例（53%）;肛门停止排气12例（33%）。发病时间1~60天（平均17天）,21例（58%）首诊为肠梗阻。发病至手术时间7~73天（平均22天）,术中见腹水29例（81%）,粪石位于回肠26例（72%）,小肠中段6例（16%）,空肠4例（12%）。术前腹部MSCT检查29例（42人次）,15例（52%）提示肠梗阻病因（“粪石”7例,“肠套叠”4例,“肿瘤”3例,“肠扭转”1例）。回顾分析上腹检查6人次未见粪石;上、下腹检查29人次2次未见粪石;全腹（上下腹盆腔）检查7人次均见粪石。10例增强扫描肠壁均见强化,而肠腔内粪石及边缘无强化。结论 粪石性小肠梗阻病因复杂临床表现无特异性,依据病史和临床表现诊断困难。全腹MSCT检查并具备相应影像诊断经验,可及时准确诊断避免术前误诊误治。

Objective To establish a more accurate diagnostic procedure for a bezoar-induced small bowel obstruction（SBO） through investigating the clinical features and the abdominal multislice spiral computed tomography （MSCT） findings of patients. Methods The records of 36 patients undergone operation with a diagnosis of a bezoar-induced SBO in our hospital between 2000 and 2013 were reviewed retrospectively. Results Of the 36 patients, the ratio of male to female and the rural to town residents were 1 to 2 and 4 to 1 respectively. 28 （78%） were over the age of 60. None had a history of upper gastrointestinal tract surgery, and all were admitted from October to March of the following year. Of clinic features, the most common one was abdominal pain （29, 81% ） , followed by vomiting （25, 69% ） , abdominal distension（ 19, 53 % ） , and no anal exhaust （12, 33% ）. Average time from the onset of a symptom to admission was 17 days （1 to 60 days）. 21 （58%） were diagnosed as SBO initially. Average time from the onset of a symptom to operation was 22 days （7 to 73 days）. Surgery revealed 29（81% ） cases had ascites; Bezoar locations were 26（72% ） cases in ileum, 6 （ 16 % ） in mid small bowel, and 4 （ 12% ） in jejunum respectively. Of 29 patient＇s abdominal MSCT images （42 person-times）, 15 （ 52% ） were suggested an obstruction etiology, of whom 7 were ＂bezoars , 4 were intussusception, 2 were tumors, and 1 was t, olvulus＇. When all the MSCT images were reviewed retrospectively, all 6 times upper abdominal images and 2 of 29 upper-lower abdominal ones were negative, but all were positive of 7 whole abdominal ones. Ten enhanced MSCT imaging showed bowel walls enhanced obviously contrast to the intraluminal bezoars. Conclusions A preoperative diagnosis of a bezoar-induced SBO based on history and clinical features may be difficult because of its complicated etiologies and nonspecific features. Whole abdominal MSCT imaging, associated with qualified diagnostic competence for bezaors, can lead to a more accurate diagnosis, and help to reduce unnecessary delays before appropriate surgical intervention.