多层螺旋CT小肠造影对回盲部良性溃疡疾病的临床价值

The clinical value of multi-slice spiral CT enterography for benign ileocecal ulcerative diseases

目的探讨多层螺旋CT小肠造影(MSCTE)在诊治回盲部良性溃疡性疾病中的价值。方法回顾性分析51例行MSCTE的回盲部良性溃疡患者的病历资料,总结回盲部良性溃疡病病因学构成及其MSCTE的影像学特点,并分析MSCTE能否提高回盲部良性溃疡病变的诊断率。结果本组病例有回盲部良性溃疡表现的主要为克罗恩病(Crohn’s disease,CD)及肠结核,但也有部分病例难以明确;该类疾病MSCTE的影像学特点有肠道管壁增厚(45例,88.2%),节段性病变(20例,39.2%),肠腔狭窄(7例,13.7%),梳齿征(7例,13.7%),腹腔脓肿、瘘管形成(1例,2.0%),肠系膜及腹膜后淋巴结肿大(13例,25.5%),相对于内镜检查,结合MSCTE回盲部良性溃疡病因的诊断率提高21.6%,其中CD、肠结核及非特异性炎的诊断率分别提高33.3%、16.7%、50.0%。结论 MSCTE检查对回盲部良性溃疡病病因的诊断价值较大,其中以CD明显,同时可对疾病并发症、肠壁增厚及肠外病变等进行评估,为临床诊治该类疾病提供重要参考。

Objective To investigate the value of multi-slice spiral CT enterography（ MSCTE） in the diagnosis and treatment of benign ileocecal ulcerative diseases. Methods Fifty-one cases of benign ileocecal ulcer after MSCTE were retrospectively analyzed. The causes of benign ilecocecal ulcer and the features of MSCTE in the ileocecal ulcerative disease were summarized. Whether MSCTE can improve the diagnostic accuracy of ileocecal ulcerative diseases were analyzed. Results The main diseases with ileocecal ulcer as clinical manifestation were intestinal tuberculosis and CD,but part cases were still unknown origin. MSCTE imaging features included intestinal wall thickening in 45 cases（ 88. 2%）,multi segmental lesions in 20 cases（ 39. 2%）,intestinal stenosis in 7 cases（ 13. 7%）,comb sign in 7 cases（ 13. 7%）,abdominal abscess and fistula in 1 case（ 2. 0%） and mesenteric and retroperitoneal lymph node swelling in13 cases（ 25. 5%）. Compared with endoscopic diagnosis,the diagnostic rate of ileocecal ulcer combined with MSCTE was increased by 21. 6%; intestinal tuberculosis,CD and nonspecific enteritis were improved by 33. 3%,16. 7% and50. 0%,respectively. Conclusion MSCTE has great diagnostic value on the causes of benign ileocecal ulcer,especially for CD,and it can evaluate the complications,intestinal wall thickening and extraintestinal manifestations. MSCTE can provide important evidences for clinical diagnosis and treatment of ileocecal ulcerative diseases.