急性坏疽性胆囊炎合并穿孔MSCT征象的临床分析

Clinical Analysis of MSCT Signs in Acute Gangrenous Cholecystitis with Perforation

目的:分析急性坏疽性胆囊炎(AGC)合并穿孔MSCT征象的临床特点。方法:选取2019年7月~2020年10月院内收治的高度怀疑AGC合并穿孔的患者65例,分析病情初期及后期MSCT征象、血清hs-CRP、D-二聚体变化。结果:AGC合并穿孔65例均经手术明确诊断,MSCT包含直接征象及间接征象,其中,直接征象以胆囊壁水肿、厚度增加,黏膜层呈线样强化且不连续,均为100.00%,间接征象胆囊邻近脂肪间隙密度过高,或可见条索状影,肝实质动脉期胆囊床呈现一过性强化,且具有肝囊肿;经MSCT三维重建技术均获得诊断,检出65例,而MSCT平扫检出63例,二者检出率差异无统计学意义(χ^(2)=2.0313,P=0.1541)。结论:AGC合并穿孔MSCT征象的临床表现多样,分为直接征象或间接征象,对制定治疗方案具有重要的临床价值。

Objective:To analyze the clinical features of acute gangrenous cholecystitis(AGC)combined with MSCT signs of perforation.Methods:Select 65 highly suspected AGC patients with perforation admitted in the hospital from July 2019 to October 2020,and analyze the MSCT signs,serum hs-CRP and D-dimer changes in the early and late stages of the disease.Results:65 cases of AGC combined with perforation were clearly diagnosed by surgery.MSCT included direct signs and indirect signs.Among them,the direct signs were gallbladder wall edema and thickness increase,and the mucosal layer showed linear enhancement and discontinuity,all of which were 100.00%.The indirect signs were high density of fat space near the gallbladder,or cord shadow,transient enhancement of gallbladder bed in hepatic parenchymal arterial phase,and hepatic cyst;By MSCT three-dimensional reconstruction technology,65 cases were diagnosed,while 63 cases were detected by MSCT plain scan.There was no significant difference in the detection rate between the two(χ^(2)=2.0313,P=0.1541).Conclusion:The clinical manifestations of AGC combined with perforated MSCT signs are diverse,divided into direct signs or indirect signs,which have important clinical value for formulating treatment plans.