多层螺旋CT在上消化道穿孔与急性阑尾炎影像学鉴别诊断及病因分析中的应用价值

Diagnostic value and etiological analysis of multi-slice spiral CT for differentiating upper gastrointestinal perforation and acute appendicitis

目的探讨多层螺旋CT(MSCT)在上消化道穿孔与急性阑尾炎影像学鉴别诊断及病因分析中的价值。方法对我院行MSCT检查的53例上消化道穿孔患者和50例急性阑尾炎患者的影像学征象进行回顾性分析与总结,分析急腹症上消化道穿孔与急性阑尾炎的MSCT影像学表现特点。结果上消化道穿孔患者出现肝门周边游离气体征、镰状韧带征、圆韧带征及胃肠壁破口的比例较急性阑尾炎患者高(P<0.05)。急性阑尾炎患者出现阑尾周脓肿、阑尾内粪石及阑尾壁增厚的比例明显高于上消化道穿孔(P<0.01)。上消化道穿孔的主要病因是胃溃疡(39.02%)、十二指肠溃疡(35.85%)及胃癌(24.53%)。结论 MSCT是鉴别上消化道穿孔与急性阑尾炎快捷、有效的检查方法,有利于临床对消化道穿孔进行诊断和治疗。

Objective To evaluate the diagnostic value and etiological analysis of multi-slice spiral CT （MSCT） for differentiating upper gastrointestinal perforation and acute appendicitis. Methods The imaging features of 53 patients with upper gastrointestinal tract perforation and 50 patients with acute appendicitis who underwent MSCT examination in our hospital were retrospectively analyzed and summarized. The MSCT imaging features of upper gastrointestinal perforation and acute appendicitis were analyzed. Results The proportion of free gas sign around hepatic hilum, sickle ligament sign,round ligament sign and gastrointestinal wall break in patients with upper digestive perforation were higher than those in acute appendicitis patients （P〈0.01）. In patients with acute appendicitis, the proportion of peri-appendicical abscess, appendicical fecolith and appendix wall thickening were significantly higher than those of upper gastrointestinal perforation （P〈0.01）. The main cause of upper gastrointestinal perforation is gastric ulcer （39.62%） and duodenal ulcer （35.85%） and stomach cancer （24.53%）. Conclusion MSCT is a rapid, simple and effective imaging technique for the differential diagnosis of gastrointestinal perforation and acute appendicitis in acute abdomen, which is helpful for clinial disagnosis and treatment of digestive tract perforation.