CT增强评价肠梗阻分型的价值

The Value of Enhanced CT in Evaluating the Classification of Intestinal Obstruction

目的:探讨CT增强评价肠梗阻分型的价值。方法:选取北京市密云区中医医院2015年1月-2021年7月122例肠梗阻患者为研究对象,所有患者均采取CT增强检查(MPR、CPR、VR),分析绞窄性、单纯性肠梗阻CT征象,并以手术病理结果作为金标准比较。结果:87例单纯性肠梗阻患者,术中可见明显梗阻点。经手术以及病理证实,肠粘连52例,结肠癌17例,粪石性梗阻11例,腹股沟疝6例,Crohn病1例。35例绞窄性肠梗中,术中可见肠壁蠕动减弱、增厚充血、水肿,部分肠壁色泽变暗。经手术以及病理证实,肠扭转12例,腹内疝6例,闭孔疝2例,股疝15例。122例肠梗阻共发现梗阻点133个,单纯性肠梗阻梗阻点87个,绞窄性肠梗阻梗阻点35个。两组患者在移行带肠壁增厚、扩张肠袢肠壁增厚、肠壁气泡等15个征象方面比较,差异均有统计学意义(P<0.05、P<0.01、P<0.001)。CT增强诊断绞窄性肠梗阻敏感度、特异度、阳性预测值、阴性预测值分别为97.14%(34/35)、93.10%(81/87)、85.00%(34/40)、98.78%(81/82),鉴别单纯性肠梗阻与绞窄性肠梗阻准确度为94.26%(115/122)(P<0.05)。结论:在临床上诊断肠梗阻分型采取CT增强技术,具有较高的诊断价值,其敏感度、特异度较高,为医生选择治疗方法提供安全可靠的依据,利于保障患者身心健康及生命安全,有助于预后效果,值得临床应用及推广。

Objective:To investigate the value of CT enhancement in evaluating the classification of intestinal obstruction.Methods:122 patients with intestinal obstruction from January 2015 to July 2021 in Miyun District Hospital of traditional Chinese medicine in Beijing were selected as the study subjects.All patients were examined with CT enhancement(MPR,CPR,VR)to analyzed the CT signs of strangulated and simple intestinal obstruction,and compared with the surgical and pathological results as the gold standard.Results:In 87 cases of simple intestinal obstruction,the point of obstruction was clearly visible intraoperatively.By operation and pathology,52 cases of intestinal adhesion,17 cases of colon cancer,11 cases of fecal stone obstruction,6 cases of inguinal hernia and 1 case of Crohn's disease were confirmed.In 35 cases of strangulated intestinal infarction,the peristalsis of intestinal wall was weakened,thickened,congested and edematous,and the color of some intestinal walls became dark.Operation and pathology confirmed that there were 12 cases of intestinal volvulus,6 cases of internal hernia,2 cases of obturator hernia and 15 cases of femoral hernia.A total of 133 obstruction points were found in 122 cases of intestinal obstruction,of which 87 cases were simple intestinal obstruction and 35 cases were strangulated intestinal obstruction.There were significant differences between the two groups in 15 signs,including intestinal wall thickening in the transitional zone,intestinal wall thickening in the dilated loop,and intestinal wall bubble(P<0.05,P<0.01,P<0.001).The sensitivity,specificity,positive predictive value and negative predictive value of enhanced CT in diagnosing strangulated intestinal obstruction were 97.14%(34/35),93.10%(81/87),85.00%(34/40)and 98.78%(81/82),respectively.The accuracy of differentiating simple intestinal obstruction from strangulated intestinal obstruction was 94.26%(115/122)(P<0.05).Conclusion:In the clinical diagnosis of intestinal obstruction,CT enhancement technique has a high diagnostic value with high sensitivity and specificity.It provides a safe and reliable basis for doctors'treatment,helps ensure the physical and mental health and life safety of patients,and facilitates the prognosis judgment.It is worth clinical application and promotion.