胃肠道穿孔放射学检查方法评价

Evaluation on Radiological Diagnostic Approach toGastrointestinal Tract Perforation

目的 :分析胃肠道穿孔病人的放射学检查资料。方法 :本组 (131例 )均摄上腹部前后立位片及双斜位片 ,其中膈下气腹征阴性共 2 1例加摄上腹部左侧卧水平投照位片 ,8例经上述方法检查膈下气腹征仍为阴性行上腹部CT平扫。结果 :前后立位片示 6 3例出现膈下游离气体 ,双斜位片示 92例出现膈下游离气体 ,2 1例左侧水平投照位片示 5例于右侧腹壁下方出现游离气体 ,8例CT扫描均于腹壁与肝外缘间出现极少量游离气体。结论 :上腹部双斜位片膈下游离气体显示率较前后立位片高 ;CT扫描能显示极少量游离气体 ,可以通过调整窗宽窗位、改变扫描体位及测CT值定性分析游离气体。故对临床高度怀疑胃肠道穿孔而普通X线仍不能明确诊断的病人 ,上腹部CT检查为行之有效的方法 。

Objective: To analyze the X -ray data of the patients with gastrointestinal tract perforation. Methods: The films of upper abdomen from AP and bilateral oblique positions were taken in all the patients, among them, 21 were additionally examined from left recumbent position,and due to negative findings for subdiaphragmatic free air following the above-mentioned methods,8 undergone CT scan. Results: Free air was identified in 63 cases from AP position, 92 from bilateral oblique position, 5 of 21 cases just beneath right abdominal wall from left recumbent position, and 8 CT-exami-ed cases outside the lateral border of the liver. Conclusion: X -ray shots from bilateral oblique positions are more sensitive for identifying subdiaphragmatic free air than those from AP position. CT scan can indicate a little of free air directly. Thus, for cases unclear with usual X -ray shots but highly suspected to be of gastrointestinal tract perforation, CT scan of upper abdomlen may be feasible for further investigation.