非创伤性消化道穿孔的CT征象及其诊断价值

CT Features and Diagnosis of Non-traumatic Gastroduodenal Perforation

目的:探讨16排螺旋CT对非创伤性消化道穿孔的可靠CT征象及其诊断价值。方法:回顾性分析68例经手术证实的非创伤性胃肠穿孔患者的CT图像,其中胃十二指肠穿孔46例,其他位置的穿孔22例。统计分析穿孔的CT征象并估算其灵敏性、特异性和似然比。结果:胃肠穿孔患者中,45例是消化性溃疡引起,1例是胃癌引起。穿孔的最常见CT征象是肠外气体(96%),其次是滞留在胃肠壁的液体或脂肪(89%)、腹水(89%)、壁缺损和/或溃疡(83%)、壁增厚(72%)。CT征象中,壁缺损和/或壁溃疡的似然比占最大(36.8),其次为壁增厚(10.5)。这些CT征象对于穿孔部位的定位诊断,灵敏性为95%,特异性为93%。结论:16排螺旋CT有助于胃十二指肠穿孔的定性和定位诊断。缺损、溃疡、胃肠壁增厚等CT征象对穿孔部位的定位具有更高的阳性预测值。

Objective: To explore the reliable CT features and diagnostic value of16 slice spiral CT in non-traumatic gastrointestinal perforation.Methods: the CT images of 68 patients with non traumatic gastrointestinal perforation confirmed by operation were analyzed retrospectively,including 46 cases of gastroduodenal perforation and22 cases of perforation in other positions.The CT features of perforation were statistically analyzed and their sensitivity,specificity and likelihood ratio were estimated.Results: among the patients with gastrointestinal perforation,45 cases were peptic ulcer and1 cases were caused by gastric cancer.The most common CT signs of perforation were outside intestinal gas (96%),followed by liquid or fat (89%),ascites (89%),wall defects and / or ulcers (83%),and wall thickening (72%) stranded on the gastrointestinal wall.In the CT signs,the likelihood ratio of wall defect and / or wall ulcer was the largest (36.8),followed by wall thickening (10.5).These CT signs have a sensitivity of 95% and specificity of 93% for locating the perforation site.Conclusion:16 slice spiral CT is helpful for the qualitative and location diagnosis of gastroduodenal perforation.CT signs such as defect,ulceration and thickening of gastrointestinal wall have a higher positive predictive value for location of perforation site.