螺旋CT检查急性缺血性肠病所致门静脉和肠壁积气的表现特点及其临床诊断价值研究*

目的 探讨急性缺血性肠病所致门静脉和肠壁积气CT表现特点,总结CT诊断的价值。方法 回顾性分析2014年6月~2017年6月我院收治的20例缺血性肠病所致门静脉和肠壁积气患者CT检查资料,使用德国西门子 Emotion 64层螺旋CT进行扫描。行纤维结肠镜检查,并取组织行病理学检查。结果 在20例患者中,缺血性肠病的病变部位在小肠者9例（空肠5例、回肠4例）,回盲部3例（累及回肠末端和升结肠）,结肠8例（横结肠3例、结肠肝曲2例、结肠脾曲1例、降结肠1例、乙状结肠1例）;所有患者均显示有门静脉积气,其中13例门静脉和肝静脉呈现广泛的积气,表现为树枝状气体影,另7例CT显示肝缘下肝静脉远端有气体影;所有患者CT均显示肠壁有积气,病变部位可见气泡状低密度影,10例为单气泡影、7例为多气泡影、3例为带状泡影;14例CT显示肠壁增厚和水肿,6例肠管扩张、肠壁变薄,4例腹腔积液;行增强CT检查10例,显示病变肠段的肠壁和肠系膜强化程度减弱,分层强化后显示为环形靶征和晕征;所有患者入院治疗后1~2 d进行CT复查,显示门静脉和肠壁积气有不同程度的吸收,其中门静脉积气完全吸收4例、明显吸收9例、少量吸收4例、无显著变化3例。肠壁积气完全吸收5例、明显吸收7例、少量吸收6例、无显著变化2例。结论 门静脉和肠壁积气的CT表现有特征性,使用 CT检查对急性缺血性肠病患者的诊断有较好的临床应用价值。

Application of CT scan in diagnosis of patients with acute ischemic bowel disease

Objective To investigate the application of CT scan in diagnosis of patients with acute ischemic bowel disease（AIBD）. Methods 20 patients with acute ischemic bowel disease were recruited in our hospital between June 2014 and June 2017,and all of them were checked-up by German SIEMENS Emotion 64 layer spiral CT scan. The data of spiral CT scan was analyzed retrospectively. All patient received fiber colonoscopy. Results Out of the 20 patients with AIBD,the site of ischemic enteropathy was at small intestine in 9 patients（jejunum in 5 patients,ileum in 4）,at ileocecal area in 3 patients（at terminal ileum and ascending colon segments）,at colon in 8 patients（at transverse colon in 3 patientss,at hepatic flexure of colon in 2 patients,at splenic flexure of colon in 1 patients,at descending colon in 1 patient,and at sigmoid colon in 1 patient）;all patients had portal gas accumulation,and 13 of them showed extensive gas accumulation in the portal vein and the hepatic vein,presenting the shadow of the dendritic gas,and in other 7 cases,CT showed a gas shadow at the distal hepatic vein;all patients showed intestinal wall gas accumulation,and there were bubble like low density shadows in the lesion area,a single gas bubbles in 10 patientss,multiple gas bubbles in 7 patients,and band shaped bubbles in 3 patients;CT showed that there was a low density shadow in the intestinal wall;CT showed the thickening and edema of the intestinal wall in 14,bowel dilation in 6,and abdominal effusion in 4;10 patients were scanned by enhanced CT examination and the intensification of the intestinal wall and mesentery in the intestinal segment of the enhanced lesion was weakened,and the lamination was characterized by a ring target and a halo sign;all patients received second CT scan,and they showed different degree of absorption in the portal vein and intestinal walls,e.g. completely absorbed in portal vein in 4 patients,obvious absorption in 9,a small amount of absorption in 4 patients,and no significant change in 3 patients,and pneumatosis was completely absorbed in intestinal segment in 5 patients,obvious absorption in 7 patients,absorption in 6 patients,and no significant change in 2 patients. Conclusion The manifestation of CT examination in patients with AIBD is characteristic,mainly by portal vein and intestinal wall gas accumulation, which might help the diagnosis in clinical practice.