CT小肠重组在蛋白丢失性肠病原发病因诊断中的价值

The Value of CT Reconstruction of Small Bowel in Diagnosing Primary Causes of Protein Losing Enteropathy

目的探讨CT小肠重组在蛋白丢失性肠病(PLE)原发病因诊断中的价值。方法回顾性分析38例确诊PLE后行CT小肠重组患者的临床资料和CT图像。重点观察胃、肠管、肠系膜血管的CT异常改变,并结合原发基础病对照分析。结果38例中,7例(18.4%)患者因发现肠瘘、肠系膜动脉-门静脉瘘、结肠肠壁多发肿块等可明确诊断原发病;27例(71%)患者累及肠管,主要表现为空肠及部分回肠肠壁全层增厚,增强后均呈轻-中度强化,粘膜面无强化,结合临床病史可诊断;4例(10.5%)患者在CT小肠重组上没有可靠的阳性征象。结论CT小肠重组在明确PLE胃肠壁、系膜血管及肠内瘘等肠内外结构改变方面具有显著优势,在PLE原发病因诊断中可发挥重要作用。

Objective To investigate the value of CT reconstruction of small bowel in diagnosing primary diseases of protein losing enteropathy. Methods Clinical data and CT imaging findings with CT reconstruction of 38 patients with confirmed protein loss bowel disease of small bowel were retrospectively analyzed. The CT abnormal changes of stomach, bowel and mesenteric vessels were observed and analyzed in combination with the primary disease. Results Out of 38 cases, 7 cases （18.4%）have primary disease that can be diagnosed clearly by finding intestinal fistula, mesenteric artery- portal vein fistula, multiple lumps of the colonic intestinal wall; 27 cases （71%） involving intestinal wall mainly show the whole layer thickening and light to moderate enhancement of jejunum and part of ileum intestinal wall, and no enhancement on mucosal surface; diagnosis may be confidently done by combining with clinical history. 4 cases （ 10.5% ） show no reliable positive signs on CT reconstruction of small bowel. Conclusion CT reconstruction of small bowel has significant advantages in defining the structural changes both inside and outside the intestinal features of PLE such as gastric and intestinal wall, mesenteric vessel and intestinal fistula. These play an important role in diagnosis of primary diseases of PLE.