多层螺旋CT血管造影对小肠梗阻诊断的临床价值

发布时间：2018-01-19 06:02

本文关键词： 肠梗阻血管造影术体层摄影术 X线计算机　出处：《临床放射学杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨多层螺旋CT(MSCT)血管造影(CTA)对单纯性小肠梗阻(SI)和绞窄性小肠梗阻(ST)影像诊断的临床价值。方法搜集63例本院经临床及手术证实的小肠梗阻患者住院病历资料进行回顾性分析。患者均做了CT平扫和CTA检查,按梗阻类型和肠系膜血管形态改变进行分类分析和统计学分析。重点对ST影像资料进行分析和讨论。结果螺旋CT可充分显示小肠梗阻中肠壁的血运状态,在SI组,增强后,肠壁CT值与同层腰大肌CT值间无显著性差异,P0.05;在ST组,肠壁强化CT值与同层腰大肌CT值间有显著性差异,P0.001。形态学表现,在SI组小肠缺血一般表现为肠管扩张、增厚,增强后有不同程度的强化,肠系膜扭转,可见"漩涡征"。在ST组特征性表现为肠壁明显增厚,增强后肠壁不强化或无明显强化,强化程度低于同层腰大肌30 HU以上,肠壁内、外膜下大量积气,呈"轨道征",肠腔内积血,肠系膜肿胀明显。结论 CTA可诊断和鉴别是否存在SI或ST,可充分显示梗阻中小肠的血运状态,特别是对小肠缺血坏死的诊断,为临床治疗提供依据。
[Abstract]:Objective to investigate the multi-slice spiral CT angiography (MSCT) (CTA) of simple intestinal obstruction (SI) and strangulated intestinal obstruction (ST) clinical imaging diagnosis. Methods 63 cases confirmed by clinical and surgical intestinal obstruction patients were hospitalized were retrospectively analyzed. Patients underwent plain CT scan and CTA scan analysis, classification analysis and statistics to change the type of obstruction and mesenteric vascular morphology. Focusing on the ST image data were analyzed and discussed. The results of spiral CT can reveal the small bowel obstruction of the midgut wall state of blood supply in the SI group, after enhancement, intestinal CT value had no significant difference, and the same layer psoas muscle CT value between P0.05; in group ST, the intestinal wall enhanced CT values were significantly different in the same layer of psoas muscle CT value, P0.001. morphological features in the SI group, intestinal ischemia had bowel dilatation, thickening, enhancement of mesenteric torsion in different degree. Visible, "whirlpool". In the ST group characterized by intestinal wall thickening, enhancement of intestinal wall enhancement or no enhancement, the enhancement degree is lower than the same layer of the psoas muscle were more than 30 HU in the intestinal wall, outer membrane under a lot of product gas, a track sign, intraluminal blood, mesenteric edema conclusion the CTA diagnosis and differential diagnosis of the presence of SI or ST, can fully display the intestinal obstruction of blood circulation, especially in the diagnosis of small bowel necrosis, provide the basis for clinical treatment.

【作者单位】：广东医学院附属中山医院放射科;
【分类号】：R574.2;R816.5
【正文快照】： 作者单位:528415中山,广东医学院附属中山医院放射科肠梗阻是临床常见急腹症,其发病原因复杂,病情进展迅速,尤其是绞窄性小肠梗阻(ST),死亡率高达80%,如得不到及时的手术治疗往往会危及患者的生命[1]。一般来讲,单纯CT平扫难与单纯性小肠梗阻(SI)鉴别,或仅能通过间接征象来推

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