大小肠双充盈法肠道CT造影对不明原因消化道出血的诊断价值

The diagnostic value of double filling method in CT angiography in the diagnosis of obscure gastrointestinal bleeding in the large and small intestine

目的:探讨大小肠双充盈法肠道CT造影对不明原因消化道出血(OGIB)的诊断价值。方法:回顾性分析30例OGIB患者临床资料,所有病例均作大小肠双充盈法肠道CT造影检查。结果:30例中恶性肿瘤5例,小肠间质瘤4例,脂肪瘤1例,血管粗大畸形4例,毛细血管扩张2例,炎性肠病5例,肠息肉3例,肠系膜上动脉血栓形成2例,肠系膜静脉血栓形成1例,憩室2例,异位胰腺1例。10经手术病理证实,6例经胶囊内镜证实,4例血管病变经DSA证实,其余10例肠道CT造影诊断与临床诊断相吻合。本组应用大小肠双充盈法肠道CT造影诊断准确率为73.3%。遗漏的病变分别为血管畸形2例,毛细血管扩张2例,小的息肉病变2例,小肠黏膜充血糜烂2例,遗漏原因为扩张的血管细小,小的息肉与肠黏膜难以区分,黏膜浅表性病变显示不敏感。结论:大小肠双充盈法肠道CT造影对OGIB的定位、定性诊断和指导临床制定治疗方案具有重要临床价值,但易漏诊浅表黏膜面病变及血管病变。

Objective： To investigate the diagnostic value of double filling method in CT angiography in the diagnosis of obscure gastrointestinal bleeding （OGIB） in the large and small intestine. Methods： Retrospective analysis of 30 patients from clinical data with OGIB, all cases underwent the intestinal double filling method CT. Results： There were 5 cases of malig- nant tumor, 4 cases of small intestinal stromal tumor, and 1 case of lipoma, furthermore coarse vascular malformation was found in 4 cases, telangieetasia in 2 cases, inflammatory bowel disease in 5 cases, intestinal polyps in 3 cases, superior mesenteric artery thrombosis formation in 2 cases, mesenterie venous thrombosis formation in 1 case, diverticulum in 2 cases, heterotopic pancreas in 1 case. Ten eases were confirmed by operation and pathology, 6 cases confirmed by capsule en- doscopy, 4 cases of vascular lesions confirmed by DSA, and the other 10 eases of intestinal CT were consistent with clinical diagnosis. The diagnostic accuracy rate of CT was 73.3% in this group by using the small intestine double filling method in this group. Omission lesions included 2 cases of vascular malformation, 2 cases of capillary dilatation, 2 cases of small poly- poid lesions, 2 cases of intestinal mucosal hyperaemia erosion. The reason was that the expansion of the blood vessels is small, small polyps and intestinal mucosa was difficult to distinguish, the superficial mucosal lesions was not sensitive. Con- clusion： The large and small intestine double filling bowel CT angiography on the positioning of OGIB, qualitative diagnosis and guiding clinical formulation treatment has important clinical value, but it is likely to be misdiagnosed by shallow table mueosa lesions and vascular lesions.