MSCT对成人小肠套叠的诊断及鉴别诊断价值

CT diagnosis and differentiation of small bowel intussusceptions in adults

目的:探讨MSCT对成人小肠套叠的诊断及鉴别诊断价值。方法:回顾性分析经临床及手术证实的67例成人小肠套叠患者的临床及MSCT表现,对比分析肿瘤性与非肿瘤性小肠套叠的临床及影像特点。结果:肿瘤性小肠套叠患者41例(肿瘤性小肠套叠组),肠套叠数量53处,其中良性肿瘤29例,恶性肿瘤12例。非肿瘤性小肠套叠患者26例(非肿瘤性小肠套叠组),肠套叠数量30处,其中原发性20例,非肿瘤性良性病变6例。非肿瘤性小肠套叠组的套管长度(4.6 cm)、套鞘直径(2.8 cm)均小于肿瘤性小肠套叠组(分别为13.4 cm和4.2 cm),差异有统计学意义(P<0.05)。非肿瘤性小肠套叠组伴肠梗阻患者(n=3)少于肿瘤性肠套叠组(n=18),发生比例差异有统计学意义(P<0.05)。肿瘤性肠套叠组9例患者为多处套叠,发生比例高于非肿瘤性肠套叠组的3例,但差异无统计学意义(P>0.05)。肿瘤性肠套叠组53处肠套叠均可见引导点。结论:成人肿瘤性与非肿瘤性小肠套叠的临床和MSCT表现有一定差异,判断肠套叠有无引导点对选择合适的治疗方案、避免不必要的手术具有非常重要的临床意义。

Objective:To explore the value of CT for diagnosis and differentiation of small bowel intussusceptions in adults.Methods:Sixty-seven adult patients with small bowel intussusceptions were included in this retrospective study.The clinical information and CT imaging features were compared between neoplastic and nonneoplastic small bowel intussusceptions.Results:There were 53 sites in 41 patients with neoplastic intussusception(benign,n=29;and malignant,n=12).There were 30 sites in 26 patients with nonneoplastic intussusception(idiopathic,n=20;and nonneoplastic benign lesions,n=6).Nonneoplastic group showed significant difference in length(4.6cm vs 13.4cm,P<0.05)and size(2.8cm vs 4.2cm,P<0.05)compared with neoplastic group.Lead points were identified in all 53 neoplastic intussusceptions.Conclusion:Clinic and CT manifestations may be valuable for differentiation neoplastic from nonneoplastic small bowel intussusceptions.Lead point identification is important for appropriate clinical determinant to reduce unnecessary surgery.