急性穿孔性腹膜炎的CT诊断

The CT Diagnosis of Acute Perforation Peritonitis

目的探讨急性胃肠道穿孔继发腹膜病变的CT表现,提高对穿孔性腹膜炎的影像学诊断与鉴别能力。方法对36例拟诊穿孔性腹膜炎患者行CT扫描,着重观察与腹膜炎相关的6种CT征象并作出术前诊断,其中28例在CT扫描后24小时内手术,并经手术和病理证实穿孔性腹膜炎的部位及程度,8例经临床综合指标明确诊断;分别计算与穿孔性腹膜炎相关的6种CT征象诊断的敏感度,特异度及正确率,术前CT诊断与临床手术病理对照采用相关系数法检验。结果术前综合运用主要CT征象对穿孔性腹膜炎的正确诊断率为86.1%(31/36),穿孔性腹膜炎的主要CT表现为腹腔游离气体影、腹腔积液、胃肠道壁增厚、壁腹膜增厚、肠系膜条纹征、肠郁张,其敏感度分别为82.1%、92.8%、67.8%、75%、89%、53.6%,特异度为25%、37.5%、62.5%、100%、89.3%、75%,腹腔积液、壁腹膜增厚、肠系膜条纹征与腹膜炎诊断有显著相关性(P<0.05)。结论根据CT征象可在术前对穿孔性腹膜炎做出较为准确的诊断。

Objective To discuss CT manifestations of peritoneum lesion due to gastrointestinal perforation, and develop the imaging diagnosis and differential diagnosis of perforation peritonitis. Methods 36 cases of suspected perforation peritonitis were examined by CT scanning, among which 28 cases underwent surgery within 24 hours of CT scanning, and the region and the degree of peritonitis were confirmed by surgery and pathology. The other 8 cases were definitive diagnosed by clinical comprehensive indicators. The sensitivity, specificity and overall accuracy of diagnosis of 6 kinds of CT signs associated perforated peritonitis were calculated separately. Correlation coefficient method was used to test the preoperative CT diagnosis and pathologic. Results Correct diagnostic rate of using the main CT signs of perforation peritonitis before operation was 86.1%（31/36）. The main CT manifestations of Perforation peritonitis were celiac free gases, peritoneal effusion, thickening of the gastrointestinal tract wall, wall peritoneal thickening, mesenteric adipose stripe and intestinal stasis dilatation. The sensitivity separately were 82.1%, 92.8%, 67.8%, 75%, 89%, 53.6%, and the specificity separately were 25%, 37.5%, 62.5%, 100%, 89.3%, 75%. Peritoneal effusion, wall peritoneal thickening and mesenteric adipose stripe have significant correlation with peritonitis diagnosis（P〈0.05）. Conclusion Conclusion CT signs can make more accurate diagnosis to perforation peritonitis prior to surgery.