粘连性肠梗阻超声分型及临床意义初探

A preliminary study on ultrasonic classification and its clinical value of adhesive intestinal obstruction

目的:建立粘连性肠梗阻的超声分型标准,并初步探讨其临床应用价值。方法:回顾性分析2014年1月至2019年10月天津市南开医院经手术及病理证实为粘连性肠梗阻的124例病例资料,总结粘连性肠梗阻超声图像特征,并按超声图像严重程度将其分为三型:单纯型(轻度)、复杂型(中度)和危重型(重度)。依据超声分型结果确定模拟手术方案,并与实际手术结果对比。结果:①单纯型(轻度)粘连性肠梗阻73例(58.9%),复杂型(中度)粘连性肠梗阻16例(12.9%),危重型(重度)粘连性肠梗阻35例(28.2%)。②单纯型(轻度)粘连性肠梗阻的特征性超声图像为肠壁与肠壁粘连和肠壁与腹壁粘连;复杂型(中度)粘连性肠梗阻特征性超声图像为粘连带和粘连性包块形成;危重型(重度)粘连性肠梗阻特征性超声图像为肠粘连致腹内疝、肠扭转、肠套叠及肠缺血坏死等并发症的形成和血性腹水。③依据超声分型结果对124例粘连性肠梗阻病例模拟手术术式,与手术结果进行对照符合率较高(87.9%)。结论:粘连性肠梗阻超声分型有助于临床判断粘连性肠梗阻的严重程度,可为临床医师制定正确的治疗方案提供一定的影像依据。

Objective To establish the ultrasonic classification criteria of adhesive intestinal obstruction(AIO)and to discuss its clinical value.Methods The data of 124 cases of AIO confirmed by surgery and pathology in Tianjin Nankai Hospital from January 2014 to October 2019 were retrospectively analyzed.The ultrasonic image features of AIO were summarized.According to the severity of ultrasound images it can be divided into three different types:simple(mild)AIO,complex(moderate)AIO and critical(severe)AIO.The surgery plan was simulated according to the ultrasonic classification results and compared with the actual surgery results.Results①The ultrasonic classification results of 124 cases of AIO were as follows:simple(mild)AIO in 73 cases(58.9%),complex(moderate)AIO in 16 cases(12.9%),critical(severe)AIO in 35 cases(28.2%).②The characteristic ultrasonic images of simple(mild)AIO were adhesion of the intestinal wall to the intestinal wall and the intestinal wall to the abdominal wall;the characteristic ultrasonic images of complex(moderate)AIO were adhesive band and adhesive mass;the characteristic ultrasonic images of critical(severe)AIO were internal hernia,volvulus,intussusception,intestinal ischemia and necrosis,and bloody ascites.③According to the results of ultrasound classification,124 cases of AIO were treated with simulated surgical procedures,and the coincidence rate with the surgical results was high(87.9%).Conclusions US classification of AIO is helpful for clinical evaluation of the severity of AIO and can provide imaging basis for clinicians to make the correct treatment plan.