肠壁囊样积气症的MSCT征象及其在临床诊治决策中作用的探讨

The MSCT Characteristics of Pneumatosis Cystoides Intestinalis and Their Role in Clinical Diagnosis and Treatment

目的:通过比较采用不同临床治疗方案的肠壁囊样积气症(PCI)患者多层螺旋CT(MSCT)征象的差异,探讨MSCT征象在PCI临床诊治决策中的作用,从而为其临床应用提供参考依据。方法:回顾性分析宁夏回族自治区人民医院2016年1月至2022年8月期间治疗的44例PCI患者资料,根据治疗方式分为保守组(34例)和手术组(10例),总结其MSCT征象特点,包括病变部位、气囊肿的大小、累计长度、在肠壁的分布、有无游离气体、门静脉积气、肠梗阻等,并比较两组间上述MSCT征象出现率的差异。结果:(1)MSCT征象:44例PCI肠壁囊样积气症气囊肿直径为0.1~3.7 cm,病变累计长度约为1.0~180 cm,1例为单发,其余为多发;浆膜下型13例(29.5%),黏膜下型15例(34.1%),混合型16例(36.4%);累及结直肠31例(70.5%),累及小肠19例(43.2%),累及胃壁、系膜处各1例(2.3%);伴有腹腔游离气体14例(31.8%);伴有肠梗阻14例(31.8%)。(2)两组间患者MSCT征象的差异:手术组与保守组之间病灶呈串珠样(90.0%vs 29.4%)、伴发门脉积气(60.0%vs 5.9%)、伴发肠梗阻(70.0%vs 20.6%)及伴发腹腔游离气体(70.0%vs 20.6%)等征象的出现率,差异均有统计学意义(P<0.05),而病变生长方式、生长部位在两组间则无统计学差异(P>0.05)。结论:PCI患者在MSCT上具有特征性表现;MSCT的征象特点可为PCI的临床治疗方案选择提供参考依据,当病灶呈串珠样改变,伴发门脉积气、肠梗阻及腹腔游离气体时要结合临床表现考虑手术可能性。

Purpose:To explore the correlation between the multi-slice spiral CT(MSCT)manifestations of pneumatosis cystoides intestinalis(PCI)and clinical treatment strategies,thereby investigating the role of MSCT manifestations in the clinical decision-making of PCI and further providing a basis for its clinical application.Methods:A retrospective analysis was conducted on data from 44 patients with PCI treated at the People's Hospital of Ninxia Hui Autonomous Region from January 2016 to August 2022.The patients were divided into conservative group(34 cases)and surgical group(10 cases)based on treatment methods,and the characteristics of their MSCT manifestations were summarized.This included the location of lesions,size of pneumatosis,cumulative length,distribution in the intestinal wall,presence of free gas,portal venous gas,intestinal obstruction,etc.Results:(1)MSCT manifestations of PCI:The diameter of pneumatosis cysts in the 44 cases ranged from 0.1 to 3.7 cm,with a cumulative length of approximately 1.0 to 180 cm.One case was solitary,while the rest were multiple;subserosal type in 13 cases(29.5%),submucosal type in 15 cases(34.1%),and mixed type in 16 cases(36.4%);involving the rectum in 31 cases(70.5%),small intestine in 19 cases(43.2%),and both the gastric wall and mesentery in 1 case(2.3%).Rectal involvement was the most common at 70.5%;fourteen cases(31.8%)had free intra-abdominal gas;fourteen cases(31.8%)had intestinal obstruction.(2)The prevalence of MSCT manifestations(beaded appearance of lesion,concomitant portal venous gas,intestinal obstruction,and free intra-abdominal gas)in surgical and conservative group were 90.0%vs 29.4%,60.0%vs 5.9%,70.0%vs 20.6%,and 70.0%vs 20.6%,respectively,with statistically significant differences between the two groups(P<0.05).There was no differences in the growth pattern and location of lesions(P>0.05).Conclusion:PCI patients exhibit characteristic manifestations on MSCT,and the MSCT manifestations are correlated with the clinical treatment strategies of PCI.When lesions show a beaded appearance and are accompanied by portal venous gas,intestinal obstruction,and free intra-abdominal gas,the possibility of surgery should be considered in conjunction with clinical presentation.