多层螺旋CT血管造影对小肠梗阻诊断的临床价值

Multislice Spiral CT Angiography in the Diagnosis of Small Bowel Obstruction Clinical Value

目的探讨多层螺旋CT(MSCT)血管造影(CTA)对单纯性小肠梗阻(SI)和绞窄性小肠梗阻(ST)影像诊断的临床价值。方法搜集63例本院经临床及手术证实的小肠梗阻患者住院病历资料进行回顾性分析。患者均做了CT平扫和CTA检查,按梗阻类型和肠系膜血管形态改变进行分类分析和统计学分析。重点对ST影像资料进行分析和讨论。结果螺旋CT可充分显示小肠梗阻中肠壁的血运状态,在SI组,增强后,肠壁CT值与同层腰大肌CT值间无显著性差异,P>0.05;在ST组,肠壁强化CT值与同层腰大肌CT值间有显著性差异,P<0.001。形态学表现,在SI组小肠缺血一般表现为肠管扩张、增厚,增强后有不同程度的强化,肠系膜扭转,可见"漩涡征"。在ST组特征性表现为肠壁明显增厚,增强后肠壁不强化或无明显强化,强化程度低于同层腰大肌30 HU以上,肠壁内、外膜下大量积气,呈"轨道征",肠腔内积血,肠系膜肿胀明显。结论 CTA可诊断和鉴别是否存在SI或ST,可充分显示梗阻中小肠的血运状态,特别是对小肠缺血坏死的诊断,为临床治疗提供依据。

Objective To assess the clinical value of Multi-slice CT（ MSCT） angiography（ Computed tomotraphy angiography,CTA） in the imaging diagnosis of simple small bowel obstruction（ simple intestinal obstruction,SI） and strangulated small bowel obstruction（ strangulated intestinal obstruction,ST）. Methods Retrospective analysis of medical records of 63 cases of patients who had surgery for intestinal obstruction in our hospital. Patients had had a CT scan and CTA examination done,then classified by type of obstruction and morphological changes of mesenteric vascular analysis and statistical analysis. Focus ST video was analyzed and discussed. Results Spiral CT results can reveal hemorrhage in small bowel obstruction of,in the SI group,which increased the bowel CT value compared topsoas with no significant difference between CT values,P 〉 0. 05; in the ST Group,there was intestinal wall enhancement on CT compared to psoas and there is a significant difference between the CT values,P 〈 0. 001. On morphology,SI group of intestinal ischemia showed intestinal dilatation and thickening,varying degrees of enhancement and superior mesenteric torsion, ＂ whirlpool＂ sign. Characteristics for the ST Group displayed that the intestinal wall was thickened wall without hyperdensity or enhancement,compared to the psoas muscle’s density of 30 HU. Considerable quantities of extraluminal gas was observed and ＂track sign＂was displayed. The superior mesenteric artery showed obvious swelling. Conclusion CTA is useful for diagnosis and differentiation for SI and ST,can reveal status of blood supply after small bowel obstruction. It isparticularly in the diagnosis of small intestine ischemic necrosis and provides the basis for clinical treatment.