肠梗阻手术指征的多排螺旋CT征象

An Exploration on the Multi-slice Spiral CT Signs of Intestinal Obstruction Indications for Surgery

目的探讨CT征象在肠梗阻患者手术适应证选择中的价值。方法回顾性分析2013年6月至2017年5月宝鸡市中医医院269例临床诊断肠梗阻病例的图像资料。其中13例放弃治疗,185例保守治疗好转,71例手术解除梗阻。肠梗阻原因:阑尾炎7例,疝7例,肿瘤22例,黏连19例,扭转9例,粪石7例,共71例。对完全性梗阻、移行带、黏连带前位、腹腔脂肪密度增高、肠粪征、漩涡征、鸟嘴征、缆绳征、腹腔积液的CT征象进行统计,采用多因素Logistic回归模型分析及析因分析小肠梗阻各CT征象及各征象联合与手术治疗的相关性。结果多因素Logistic回归模型分析显示,完全性梗阻、移行带、黏连带前位、肠粪征、腹腔积液5个征象在手术组与非手术组之间具有统计学意义(完全性肠梗阻P=0.036;移行带P=0;黏连带前位P=0.024;肠粪征P=0.006;腹腔积液P=0),其特异度、敏感度、阴性预测值、阳性预测值,OR值均>1。结论完全性梗阻、移行带、黏连带前位、肠粪征、腹腔积液5个征象对肠梗阻患者手术时机的选择具有良好的参考价值。

Objective To investigate the value of CT signs in the selection of operative indications in patients with intestinal obstruction. Methods Retrospective review of 269 cases of clinical diagnosis of intestinal obstruction,including 185 cases of conservative treatment improved,71 surgical removal of obstruction,13 people giving up treatment. Causes of intestinal obstruction： 7 cases of appendicitis,7 cases of hernia,22 cases of tumor,19 cases of adhesion,9 cases of torsion,7 cases of bezoars,a total of 71 cases,stading CT signs of surgery and non surgery group： complete obstruction,transitional zone,adhesions front and abdominal fat density increased,intestinal feces sign,whirlpool,beak,cable sign,peritoneal effusion. The differences of CT signs between operation group and conservative treatment group were statistically analyzed.Results Multivariate logistic regression analysis showed that the complete obstruction,transitional zone,belt,fecal intestinal adhesion syndrome,peritoneal effusion 5 signs were statistically significant between operation group and non operation group（ P〈 0. 05）,to predict the specificity,sensitivity,negative predictive value,positive,OR value was 〉 1. Conclusion The 5 signs of complete obstruction,transitional zone,anterior adhesion zone,fecal bowel sign and peritoneal fluid have good reference value for the timing of operation for patients with intestinal obstruction.