肠出血与缺血疾病CT征象对比研究

Comparative Study on CT Signs of Intestinal Hemorrhage and Ischemic Disease

目的分析肠出血与缺血疾病的CT征象,探讨64层螺旋CT诊断肠出血与肠缺血疾病的临床应用价值。方法回顾性分析63例经内镜检查、DSA或手术病理证实为肠出血与肠缺血疾病患者的CT表现。按照临床及CT表现分为两组:第一组肠出血组42例,另一组肠缺血组21例,分析CT直接及间接征象。结果第一组炎症性肠病18例,肠道肿瘤13例,溃疡8例,血管畸形3例;另外一组肠系膜上静脉血栓形成3例、肠系膜上动脉栓塞5例、肠系膜上动脉狭窄6例、肠扭转3例、肠套叠2例、绞窄性肠梗阻2例;出血直接征象对比剂外溢到肠腔,间接征象只显示病变本身改变,未见对比剂外溢。缺血直接征象血管腔内充盈缺损或血管腔狭窄;间接征象包括肠管不强化、肠壁积气等有特异性,肠扭转可见漩涡征。结论肠道出血性病变多于缺血性病变,炎症、肿瘤、血管畸形大部分表现为出血;血栓形成、栓塞、狭窄、套叠及扭转表现为缺血;CT增强直接及间接征象有利于明确诊断;CTA重建还可以发现责任血管。

Objective To investigate the clinical value of 64-slice spiral CT in diagnosising intestinal hemorrhage and ischemia.Methods 63 patients with intestinal hemorrhage and intestinal ischemia confirmed by endoscopic examination,DSA or surgical pathology were retrospectively analyzed.According to clinical and CT futures,the patients were divided into two groups:the first group of 42 patients with hemorrhage,and the other group of 21 patients with ischemia,and the direct and indirect signs of CT were analyzed.Results In the first group,there were 18 cases of inflammatory bowel disease,13 cases of intestinal tumor,8 cases of ulcer,3 cases of vascular malformation.In the other group,there were 3 cases of superior mesenteric vein thrombosis,5 cases of superior mesenteric artery embolization,6 cases of superior mesenteric artery stenosis,3 cases of intestinal volvulus,2 cases of intussusception,and 2 cases of strangulation intestinal obstruction.The direct sign of intestinal bleeding is the contrast agent effusion into the lumen,only the pathological changes,no contrast agent effusion was observed is the indirect sign.Intracavitary filling defect or epigastric stenosis is a direct sign of ischemia.Indiret signs include enhanced bowel no strengthened,specific intestinal wallgas,volvulus,and vortex.Conclusion Hemorrhagic intestina lesions were more than ischemic lesions,and most of the inflammation,tumorand vascular malformation were bleeding.Thrombosis,embolism,stenosis,and overlap were characterized by ischemia.The direct and indirect signs of CT enhancement are helpful for definite diagnosis.CTA reconstruction also revealed responsible vessels.