多层螺旋CT对小肠梗阻病因的诊断价值

目的:评价多层螺旋GT对小肠梗阻病因的诊断价值.方法:41例小肠梗阻病例进行了上下腹部CT平扫加增强扫描,利用工作站获得重建图像,并将CT结果与手术病理对照.结果:41例小肠梗阻患者均经手术证实,其中良性病变29例(包括胆石性梗阻,腹外疝或腹内疝,粘连性肠梗阻,肠气肿,炎性纤维性息肉,粪便纤维素性梗阻,肠套叠伴良性病变,小肠克罗恩病),恶性病变12例(包括胃癌术后转移,原发性或继发性小肠恶性肿瘤,结肠恶性肿瘤,肠套叠伴恶性病变).多层螺旋CT正确诊断梗阻病因39例(95.1%),误诊漏诊2例.结论:多层螺旋CT是诊断小肠梗阻病因的有效且较准确的方法.     

腹股沟及其周围疝所致肠梗阻CT诊断

目的 探讨CT对腹股沟及其周围疝所致肠梗阻的诊断价值.资料与方法 回顾性分析17例经手术证实的腹股沟及其周围疝所致肠梗阻的CT表现,CT检查包括全腹部平扫、动脉期及门脉期增强.结果 17例患者均有不同程度的肠梗阻表现,腹股沟斜疝9例,CT表现为疝囊内肠管从腹壁下动脉外侧、腹股沟韧带前上方走行,行经腹股沟管内;直疝1例,CT表现为扩张的小肠肠管从腹壁下动脉内侧的直疝三角区(Hesselback三角)直接由后向前突出,疝囊不进入阴囊;股疝3例,CT表现为股疝疝囊位于股三角区、耻骨结节水平线以后、腹股沟韧带后下方;闭孔疝4例,CT表现为闭孔外肌与耻骨肌之间的肠管影和腹部肠管相连.结论 CT检查能明确诊断腹股沟及其周围疝所致肠梗阻.     

螺旋CT在小肠梗阻诊断中的价值

目的:探讨螺旋CT在小肠梗阻诊断中的价值。方法:对64例小肠梗阻患者肌注低张剂、口服对比剂后行螺旋CT平扫和增强扫描,并与手术病理结果对照。结果:机械性小肠梗阻59例(其中肠肿瘤17例,炎性病变7例,腹外疝8例,腹内疝5例,肠粘连8例,腹茧症5例,胆石3例,肠套叠3例,肠扭转2例,粪块1例),CT诊断正确55例,诊断符合率93%。麻痹性肠梗阻5例,CT诊断正确3例,诊断符合率为60%。8例绞窄性肠梗阻,7例CT诊断正确,诊断符合率88%。结论:CT判断小肠梗阻的有无以及明确梗阻的部位、原因、程度和肠管缺血具有较高的准确性,是诊断小肠梗阻的可靠方法。     

螺旋CT诊断腹部疝的临床应用价值

目的:探讨螺旋CT诊断腹部疝的临床应用价值.材料和方法:回顾性分析石景山医院2002～2008年经手术证实的33例腹部疝的螺旋CT表现.结果:33例中,根据疝所在的位置,螺旋CT诊断腹股沟区疝17例、脐疝3例、腹腔内疝3例、闭孔疝2例和外伤性腹壁疝、腹壁切口疝各4例.33例腹部疝的疝内容物均为小肠;螺旋CT表现为肠梗阻33例;肠系膜血管分布形态改变14例;螺旋CT增强扫描疝囊内肠管正常强化13例,强化减弱或延时强化16例,无强化4例,当肠管发生强化减弱、延时强化或无强化时可确定肠管已绞窄和(或)坏死(20例).肠坏死继发肠穿孔3例.结论:螺旋CT不但能正确显示腹部疝的存在与分型,而且能根据CT增强扫描后疝出肠管的强化程度判断肠管是否发生绞窄和(或)坏死.     

多层螺旋CT诊断肠梗阻的临床应用价值

目的探讨多层螺旋CT诊断肠梗阻性质及病因的临床价值。方法回顾分析经临床手术病理证实为肠梗阻的22例患者的CT平扫和/或强化资料,并与手术病理结果对照,分析肠梗阻的CT表现。结果 22例患者CT均诊断为肠梗阻,20例(91%)病因诊断与手术病理一致,包括肠道肿瘤3例,肠粘连6例,肠套叠2例,斜疝2例,小网膜囊疝1例,肠扭转2例,肠系膜上动脉栓塞1例,粪石3例。结论多层螺旋CT能快速准确的显示肠梗阻的部位及病因,并能清晰显示肠管周围情况,对临床治疗方案及预后评估有重要价值。     

多层螺旋CT后处理技术在肠梗阻诊断中的价值

目的:评价多层螺旋CT在肠梗阻诊断的临床意义。方法:对34例临床怀疑为肠梗阻的病例进行多层螺旋CT扫描检查,22例扫描前60min分次口服等渗甘露醇溶液1000～1500ml,余12例因腹张、呕吐频繁等原因未服甘露醇溶液。均行平扫+三期增强扫描。成像方法包括薄层横断面、多方位重建成像(MPR)、容积再现法(VR)和最大密度投影(MIP)血管成像。结果:在34例临床怀疑肠梗阻病例中,经MSCT检查明确为肠梗阻者27例,其中低位小肠梗阻14例,较高位小肠梗阻2例,11例为不同部位的结肠梗阻。其中炎性病变9例、粘连8例、肠道原发肿瘤7例、肿瘤术后复发或转移2例、腹股沟斜疝1例。结论:多层螺旋CT对判断肠梗阻的部位、程度及原因、有无闭袢性肠梗阻及肠缺血、肠绞窄有重要临床意义。     

64层螺旋CT对粪石性小肠梗阻的诊断

目的 评价64层螺旋CT对粪石性小肠梗阻的定性、定位诊断价值及早期的CT影像学检查特点.方法 对23例经手术和临床证实为粪石性小肠梗阻的64层螺旋CT表现进行回顾性分析.结果 64层螺旋CT对粪石性小肠梗阻的定位诊断23例(100%)均正确:空肠4例,空回肠交界处5例,回肠14例;21例(91.3%)定性诊断正确,2例误诊为肿瘤.主要的CT表现有:肠腔内类圆柱形或类椭圆形相对低密度灶(21/23,91.3%),胶囊样密度增高影(18/23,78.3%),病 灶内有蜂窝状气泡 影(20/23,87.0%),邻近肠壁强化(20/20,100%),近段小肠扩张并见液气界面(23/23,100%),远端肠管正常或塌陷(23/23,100%).结论 粪石性小肠梗阻具有典型的CT表现,64层螺旋CT对粪石性小肠梗阻的定位、定性诊断具有重要的临床价值.     

多层螺旋CT对老年肠梗阻诊断的价值

目的:探讨多层螺旋CT(MSCT)对老年肠梗阻的诊断价值.方法:对36例老年肠梗阻患者MSCT表现进行分析,其中30例行手术治疗,6例保守治疗.结果:MSCT准确显示肠梗阻的病例为100%.30例手术治疗患者中,28例手术结果与MSCT表现相符,包括肠道肿瘤15例,粘连性肠梗阻6例,腹外疝2例,胆石性肠梗阻2例,炎性作用引起的肠梗阻3例.结论:MSCT对老年肠梗阻的程度、梗阻部位及梗阻原因的诊断有重大意义,可作为肠梗阻的首选检查方法.     

多层螺旋CT对几种罕少见病因肠梗阻诊断的价值

目的 评价多层螺旋CT(MSCT)对罕少见病因肠梗阻诊断的价值.资料与方法 回顾性分析14例经手术证实的罕少见病因肠梗阻的CT征象及临床表现,CT检查包括全腹部平扫、动脉期及门静脉期增强扫描.结果 14例患者均有程度不等的肠梗阻表现.其梗阻原因分别为腹茧症2例、乙状结肠周围疝2例、闭孔疝3例、肠石1例、胆石6例.结论 MSCT检查除了能明确诊断肠梗阻外,还能明确导致肠梗阻的罕少见病因.     

多层螺旋CT扫描及重建技术在腹股沟疝分类中的应用

目的评估多层螺旋CT扫描及三维重建技术在区别腹股沟直疝及斜疝的应用。方法收集54例同时行CT扫描及外科疝修补术的腹股沟疝病例资料,分别观察CT轴位、冠状位及矢状位对腹股沟疝的显示情况并区分腹股沟斜疝及直疝,并与手术结果对照。结果 MSCT及重建可以清晰直观地显示腹股沟疝并区分直疝及斜疝。其中冠状位对腹股沟结构显示最清楚,对腹股沟疝分类诊断正确率100%;矢状位次之,诊断正确率94%;横断位诊断正确率87%。结论 MSCT及高分辨率冠状位及矢状位重建可以精确地显示以及辨别腹股沟直疝、斜疝。     

Vascular complications in intestinal obstructions. The role of computed tomography

INTRODUCTION: We investigated CT capabilities in showing vascular complications (ischemia, infarction) secondary to intestinal obstruction. SUBJECTS AND METHODS: 32 patients with small bowel obstruction, subdivided in two groups, were examined with CT. The first group consisted of 12 patients with small bowel obstruction complicated by ischemic injury. It was due to loop strangulation in 10 cases and loop distension secondary to colon carcinoma in 2 cases. At surgery the loop strangulation was caused by adhesions in 9 cases and by jejunal hernia in 1 case. Vascular complications were segmentary small bowel infarction in 7 cases, colonic infarction in 2 cases and ischemia, which was resolved after loop debridement, in 3 cases. The second group consisted of 20 patients with intestinal occlusion due to adhesions complicated by a closed loop in 4 cases. All patients were examined with(out) i.v. contrast agent administration. Filling of the intestinal loops by oral contrast agent was never performed. RESULTS: CT identified the vascular injury secondary to intestinal obstruction in 11/12 patients (91%). In one case it was not possible to diagnose mild ischemia, which was found of surgery. CT findings were: loops distention in all the cases; wall thickening in 11 cases with intramural gas in 8 cases and slight contrast enhancement in 1 case; ascites in 2 cases; mesenteric edema in 9 cases; gas at the mesenteric root in 1 case. In the control group, small bowel obstruction was diagnosed with CT in all cases based on the presence of distended loops up to the occlusion site. Parietal alterations above the lesion were never found. CONCLUSION: CT is a sensitive tool for diagnosing small bowel obstruction and for assessing the site and cause of obstruction. CT plays a pivotal diagnostic role in vascular complications, giving very important indications for a correct treatment.     

超声在腹部平片阴性肠梗阻中的诊断价值

目的研究超声在腹部X线平片检查阴性的肠梗阻诊断中的价值。方法回顾我院2002～2011年经CT、手术证实为肠梗阻且腹部X平片为阴性而B超检查为阳性的36例患者的临床资料,对诊断结果进行分析。结果36例患者经CT、手术证实梗阻原因中肠套叠18例,肠道肿瘤12例,粘连索带引起内疝3例,粪石梗阻1例,腹腔炎症引起肠梗阻2例。结论超声在肠梗阻诊断中具有一定的意义,可作为腹部X线平片诊断肠梗阻的补充检查。     

Bowel obstruction following liver transplantation: clinical and ct findings in 48 cases with emphasis on internal hernia

PURPOSE: To review the incidence, cause, and radiologic findings of bowel obstruction in patients who have undergone orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Retrospective review of 4,001 cases of OLT revealed 48 cases of bowel obstruction in 44 patients. Seventeen computed tomographic (CT) scans and seven barium-enhanced radiographs were reviewed to determine level and cause. Surgical proof was available in 45 cases, while three had characteristic clinical and radiographic features. RESULTS: Adhesions caused the obstruction in 19 cases in 16 patients; three had bowel ischemia. Internal hernias caused obstruction in 18 patients; all obstructions were transmesenteric or retroanastomotic and occurred with choledochoenteric anastomosis. Seven patients had volvulus; four had bowel ischemia. CT signs of internal hernia included mesenteric vascular abnormalities and clusters of dilated small-bowel segments that displaced the colon away from the abdominal wall. Prospective diagnosis of internal hernia was made in only one case. Incisional or inguinal hernia caused obstruction in seven patients; CT was used just once. Four patients had neoplastic bowel obstruction, three due to posttransplantation lymphoproliferative disorder and one due to colon carcinoma. CONCLUSION: Liver transplantation was complicated by bowel obstruction in 48 (1.2%) of 4,001 cases. While adhesions and incisional hernias are common and well recognized, other causes are more challenging to diagnose. The CT findings reported here may allow more accurate diagnosis of internal hernia.     

MSCT对肠梗阻病因诊断的探讨

目的：探讨MSCT对于肠梗阻病因诊断的价值。方法：回顾性的对87例经手术及临床治疗证实的肠梗阻患者的MSCT检查表现进行分析,并与临床结果加以对比。结果：MSCT能够正确诊断肠套叠及肠扭转所致的肠梗阻,临床符合率达100%;对于肠粘连及肿瘤所致的肠梗阻,MSCT诊断正确率也很高,临床符合率分别为90%及91.7%;对于腹内疝所致的肠梗阻,因其解剖复杂,MSCT诊断有一定难度,临床符合率为80%;对于胃石及胆石所致肠梗阻,诊断较差,临床符合率为60%。结论：MSCT对于肠梗阻有较高的病因诊断价值。     

多层螺旋CT在肠梗阻病因诊断中的价值

目的 探讨多层螺旋CT在肠梗阻病因诊断中的价值.方法 49例经手术或临床明确诊断的肠梗阻患者行全腹部CT平扫和增强扫描检查,5例行三维后处理重建.由2位高年资放射医师用盲法回顾性分析其CT表现,根据CT图像上"移行带"区肠壁的厚度、密度和强化程度,肠管管腔和肠系膜区的形态和密度改变,结合病史,分析肠梗阻的病因.结果 CT提示病因诊断46例,占94%,包括肠粘连13例、肿瘤11例、疝4例、血运性肠梗阻4例、胆石2例、胃石2例、结肠内容物阻塞4例、麻痹性肠梗阻3例和阑尾炎阑尾脓肿3例.病因诊断不明或误诊3例.结论多层螺旋CT在肠梗阻病因诊断中有很高的临床应用价值,可作为临床肠梗阻诊断的首选检查方法.     

腹内疝病理基础及分型的多层螺旋CT诊断探讨

目的:探讨腹内疝多层螺旋CT(MSCT)表现的病理基础及分型,扩大影像学诊断本病的应用范围。方法:回顾性分析经手术证实的18例腹内疝的MSCT表现。结果:18例术前MSCT均表现为小肠梗阻,7例发生肠管绞窄。11例诊断为腹内疝,包括十二指肠旁疝3例,网膜孔疝1例,盲肠周围疝1例,肠粘连束带疝6例。术后证实18例均有小肠梗阻,其中,十二指肠旁疝4例,网膜孔疝1例,肠系膜裂孔疝1例,大网膜裂孔疝1例,盲肠周围疝1例,术后形成腹内疝有肠粘连束带疝9例,胃切除术吻合口后疝1例。闭襻性肠梗阻和肠系膜及其血管的绞窄是腹内疝的病理基础,也构成了CT诊断的共性征象,腹内疝的解剖分型则是CT诊断的个性特征。结论:肠粘连束带疝将成为腹内疝分类中新的分型,MSCT能较准确诊断腹内疝,为临床治疗提供可靠证据。     

腹内疝的临床与CT表现(附8例分析)

目的:探讨腹内疝的临床特点和CT表现。方法:回顾性分析经手术证实的8例腹内疝患者的临床特点和CT表现。结果:8例中十二指肠旁疝3例,2例术前诊断正确,1例误诊为肠扭转;5例经肠系膜疝中4例有腹部手术史。8例患者的CT表现中共同征象包括肠梗阻,小肠异常聚集,肠系膜血管异位、伸拉、聚集或扩张。其他肠管移位。左侧十二指肠旁疝表现为胃和胰尾间或胰尾后方囊袋状异常排列的肠管;右侧十二指肠旁疝表现为十二指肠圈部位囊袋状肠管伴肠系膜血管紊乱;经肠系膜疝表现为小肠异常排列,无大网膜脂肪覆盖,结肠中心性移位,常伴小肠梗阻或肠绞窄。5例经肠系膜疝的CT征象均能明确或高度提示内疝。结论:腹内疝的CT表现有一定特征性,CT可对大多数病例作出明确诊断。