小肠腔内非肿瘤性梗阻MSCT分析

MSCT analysis of non tumor obstruction in the small intestine

目的探讨多层螺旋CT(multislice spiral computed tomography,MSCT)诊断小肠腔内非肿瘤性梗阻的应用价值。方法收集本院经手术证实的13例小肠内非肿瘤所致肠梗阻患者的MSCT资料;分析梗阻物的形成原因及MSCT表现特点。结果 13例小肠腔内非肿瘤性肠梗阻中,粪石性梗阻5例,胆石性梗阻5例,蛔虫性梗阻2例,金属异物性梗阻1例。5例粪石性肠梗阻中,合并胃内粪石2例;5例胆石性肠梗阻中,胆-肠瘘3例,胆-胃瘘2例;腹腔积液8例,少量积液5例,中等量积液3例。非肿瘤性肠梗阻具有特征性的MSCT表现:胆石性肠梗阻呈"同心圆"高密度影,粪石性肠梗阻呈"气泡征"及"瓶塞征",蛔虫性肠梗阻呈"面条断面征",金属异物性肠梗阻呈"气泡征"伴金属伪影。12例非肿瘤性小肠梗阻术前作出了准确病因分析,准确率92.3%,1例蛔虫性梗阻因呼吸运动伪影干扰,术前误诊为粪石。结论熟练掌握小肠腔内非肿瘤性梗阻的MSCT表现,对提高小肠腔内非肿瘤性梗阻的病因分析及临床制定合理的治疗方案具有重要意义。

Objective To investigate the value of multislice spiral computed tomography(MSCT)applying in the diagnosis of non-neoplastic obstruction in the small intestine.Methods MSCT data of 13 patients with non-neoplastic obstruction in the small intestine confirmed by surgery in our hospital.The causes of obstruction and MSCT features were analyzed.Results Among the 13 patients with non-neoplastic obstruction in the small intestine,5 cases of obstruction were caused by bezoar,5 cases of obstruction were caused by gallstones,2 cases of obstruction were caused by ascaris and 1 case of obstruction was caused by metallic foreign bodies.In the 5 patients with obstruction caused by bezoar,2 patients were combined with gastric bezoar.In the 5 patients with obstruction caused by gallstones,3 patients had biliary-intestinal fistula and 2 had biliary-gastric fistula.Seroperitoneum was found in 8 patients,with a small amount of effusion in 5 patients and a moderate amount of effusion in 3 patients.Non-neoplastic obstruction in the small intestine showed characteristic MSCT manifestations:obstruction caused by gallstones presented high-density shadow in“concentric circles”,obstruction caused by bezoar presented“bubble sign”and“cork sign”,obstruction caused by ascaris presented“noodle-section sign”,obstruction caused by metallic foreign bodies presented“bubble sign”accompanied by metal artifacts.Accurate etiological analysis was obtained preoperatively in 12 surgeries for non-neoplastic obstruction in the small intestine(accuracy,92.3%).Due to respiratory motion artifacts,1 patient with obstruction caused by ascaris was preoperatively misdiagnosed as obstruction caused by bezoar.Conclusion Mastering the MSCT performance of non-neoplastic obstruction in the small intestine is of great significance to improve the etiological analysis and clinical treatment of non-neoplastic obstruction in the small intestine.