螺旋CT平扫对预测胃肠道穿孔部位的准确性研究

目的探讨螺旋CT平扫对预测胃肠道穿孔定位的准确性,为外科医生提供有价值的资料。方法选择中山市坦洲医院放射科2011年1月-2013年1月就诊的胃肠道穿孔患者62例,均行螺旋CT平扫,对穿孔部位进行预测,并与手术病理资料进行比较,观察CT诊断不同穿孔部位准确率,对有价值的CT征象进行总结。结果螺旋CT平扫预测穿孔部位分别为胃溃疡穿孔36例,十二指肠溃疡穿孔11例,外伤性空腔脏器穿孔8例,溃疡性结肠炎穿孔2例,肿瘤穿孔1例。与手术病理比较,胃溃疡穿孔、十二指肠溃疡穿孔、外伤性空腔脏器穿孔的符合率均达100%,溃疡性结肠炎穿孔、肿瘤穿孔的符合率分别为40.00%、50.00%,总符合率为93.55%。主要的CT征象为肠系膜间隙中游离气体、节段性胃肠壁增厚、肠壁灶状缺损、腔外气泡集中于邻近肠壁、腹部与盆腔中腔外气体、内脏周围脂肪索条影、腔外液体及脓肿。结论螺旋CT平扫不仅可准确定性,而且对穿孔部位可作出准确判断,具有较高的临床价值。

The study of accuracy of prediction of spiral CT scan on gastrointestinal perforation position

Objective To explore the accuracy of prediction of spiral CT scan on gastrointestinal perforation position and provide valuable information for surgeon.Methods Sixty-two patients with gastrointestinal perforation in department of radiology of Tanzhou Hospital of Zhongshan City from Jan.2011 to Jan.2013 were given spiral CT scan,the perforation position was predicted and surgical pathology datas were compared.The accuracy of CT diagnosis of different perforation position was observed and valuable CT signs was summarized.Results Spiral CT scan predicting perforation position were 36 cases of gastric ulcer perforation,11 cases of duodenal ulcer perforation,8 cases of traumatic cavity viscera perforation,2 cases of ulcerative colitis perforation,1 case of tumor perforation.Compared with surgical pathology,the coincidence rates of gastric ulcer perforation,duodenal ulcer perforation and traumatic cavity viscera perforation were 100％.The coincidence rates of ulcerative colitis perforation and tumor perforation were 40.00％,50.00％ respectively.The total coincidence rate was 93.55％.The main CT signs were included with free gas in mesenteric gap,segmental thickening of gastric wall,focal intestinal wall defect,outside the cavity bubble in adjacent intestinal wall,abdominal and pelvic cavity gas,visceral fat rope around the shadow,liquid and abscess cavity.Conclusion The spiral CT scan can not only accuratly judge in perforation,but also accuratly locate perforation position,it has high clinical value.