粘连性肠梗阻的CT表现与手术对照分析

CT diagnosis and surgical treatment of adhesive ileus

目的分析粘连性肠梗阻的cT表现，评估cT对粘连性肠梗阻的诊断价值。方法回顾性分析83例经手术证实的粘连性肠梗阻的CT表现，由2位主治医生采用盲法就肠梗阻是否存在、梗阻程度、梗阻部位、梗阻移行部粘连方式及是否伴有绞窄性肠梗阻共同讨论作出诊断，并将cT分析结果与手术病理进行对照。结果对于存在肠梗阻、梗阻程度及梗阻位置的CT诊断准确率均为100％。梗阻移行部粘连形式包括：肠粘连形成腹内疝（44例）、肠管粘连成团（12例）、肠管扭曲成角（8例）、肠管与腹壁粘连（6例）、粘连肠管挛缩狭窄（5例）、粘连带压迫（4例）、粘连致肠扭转（1例）。CT对绞窄性肠梗阻的诊断准确率为78％，敏感性为47％，特异性为100％，阳性预测值为100％，阴性预测值为73％。结论CT能明确诊断形成肠梗阻的不同粘连方式及是否伴有绞窄性肠梗阻。

Objective To analyze CT findings in adhesive intestinal obstruction caused by different adhesion pattern. Methods Clinical data of 83 adhesive intestinal obstruction cases proved by laparotomy were reviewed. Before surgery two experienced abdominal radiologists randomly double blindly inspected and evaluated the CT findings, as to whether there was intestinal obstruction, the severity of obstruction, the site of obstruction, the adhesion type of obstruction and the diagnosis of strangulated intestinal obstruction, the consensuses were accomplished by discussion. Results The accuracy of diagnosis was 100% for the existence of obstruction, the severity of obstruction and the site of obstruction. There were intra-abdominal hernia caused by intestinal adhesion （44 cases ）, a cluster of loop （ 12 cases ）, bowel twisted angle （8 cases ）, the intestine and abdominal adhesions （6 cases ）, intestinal adhesion contracture stenosis （5 cases）, adhesive band compression （4 cases）, intestinal volvulus caused by adhesion （1 case）. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CT in diagnosing strangulated intestinal obstruction were 78%, 47%, 100%, 100%, 73%, respectively. Conclusion CT can clearly diagnose different adhesion pattern leading to ileus and ensuing strangulation.