螺旋CT在消化道穿孔中的诊断价值

目的：分析CT在消化道穿孔中的诊断价值。方法回顾性分析51例经手术证实的消化道穿孔病例，术前行立位腹部平片检查者41例，腹部CT扫描者51例，比较两种检查方法在消化道穿孔中的诊断价值。结果41例X线片检出游离气体26例，CT检出50例，CT检出率高于普通X线检查（P＜0．05）。CT显示腹内游离气体呈新月状或小气泡影（50例），胃肠穿孔处周围局限性积液或蜂窝织炎（34例），阑尾周围脓肿（3例），肠梗阻（5例），胃肠壁增厚（25例），胃肠壁肿块（2例），胃肠壁缺损（4例），腹水（30例）。CT对穿孔病因的诊断符合率为68．6％（35/51），对穿孔部位的诊断符合率为88．2％（45/51）。结论螺旋CT诊断胃肠道穿孔是一种有效的检查方法，且对穿孔部位和病因的诊断也具有重要价值。

Diagnostic value of spiral CT for gastrointestinal perforation

Objective To analyze the value of Spiral CT in the diagnosis of gastrointestinal （GI） tract perforation .Meth-ods 51 cases that had gastrointestinal tract perforation confirmed by surgery were retrospectively studied in this research . All these cases had CT examination and 41 cases had abdominal plain film examination on the same day .Moreover ,the di-agnostic value of the two methods in gastrointestinal （GI） tract perforation was compared .Results Free air was only shown in 26 cases out of 41 by X-ray examination ,but 50 cases out of 51 by Spiral CT examination .CT examination detec-tion rate was higher than ordinary X-ray examination （ P〈0 .05） .The direct CT sign of gastrointestinal tract perforation was“crescent”or“bubble”sign formed by the air within peritoneal cavity ,which were detected in 50 cases .The other find-ings were showing the localized fluid or cellulites adjacent to the gastrointestinal tract perforation （n=34） and appendiceal abscess （n=3） .5 cases were associated with bowel obstruction ,25 cases with gastrointestinal wall thickening ,2 cases with gastrointestinal mass ,4 cases with gastrointestinal wall defect ,and 30 cases with ascites .Of the 51 patients ,the sensitivity of CT in diagnosis of the site of perforated digestive tract was 88 .2% （45/51） and the accuracy of etiology ascer-tained by CT was 68 .6% （35/51） .Conclusion Spiral CT examination is an effective scan method for the diagnosis of gas-trointestinal perforation ,and it is important to the location and cause of perforation diagnosis .