多层螺旋CT诊断粘连性小肠梗阻征象及其临床价值探讨

目的:探讨多层螺旋CT在诊断粘连性小肠梗阻及其重要合并症中的应用价值.方法:回顾性分析经手术证实的18例粘连性小肠梗阻的影像表现和临床意义.结果:18例中16例与手术所见符合,2例误诊为肠扭转;16例均可见肠管"移行带".5例合并绞窄性肠梗阻,其中3例为粘连性肠梗阻合并肠扭转,2例为粘连带下疝形成闭袢,均与手术所见吻合;3例手术时发现有肠坏死,而CT未能作出提示.结论:肠管"移行带"是粘连性小肠梗阻的较为典型的CT征象,多层螺旋CT诊断粘连性小肠梗阻具有较高的临床应用价值.     

CT对绞窄性肠梗阻的诊断价值

目的：探讨CT对绞窄性肠梗阻的诊断价值。方法：收集我院21例绞窄性肠梗阻（实验组）和26例单纯性肠梗阻（对照组）的CT影像资料,进行回顾性分析,探讨对绞窄性小肠梗阻有价值的CT征象。结果：绞窄性肠梗阻的CT影像改变主要来源于3方面：绞窄肠管,肠系膜及其血管,血性腹水。结论：靶征、同心圆征、肠壁积气、漩涡征、血性腹水、肠壁强化异常为诊断绞窄性肠梗阻敏感性和特异性较高的征象。     

12例肠扭转CT诊断中肠管位置异常的征象分析

<正>肠扭转是一种闭袢性肠梗阻,可迅速形成绞窄性肠梗阻导致肠管坏死穿孔和腹膜炎,危及患者生命,及时正确的诊断至关重要。CT现已成为肠扭转的首要诊断方法。既往文献对CT肠管及系膜漩涡征描述较多,而对肠管位置异常的其它征象,如肠管换位征、肠管异常纠集成簇状排列等征象描述不多。笔者收集了12例经手术证实为肠扭转的病例,对其CT图像中肠管位置异常征象进行回顾性分析,旨在提高肠扭转的CT诊断率。     

粘连性肠梗阻手术决策应重视的问题

目的 探讨粘连性肠梗阻的病因、诊断及治疗。方法 我科收治的148例粘连性肠梗阻患的临床资料进行回顾性总结、分析。结果 全组148例有131例发生于腹腔手术后。行腹部X线平片检查114例，CT扫描32例，腹部B超检查45例。行非手术治疗93例，手术治疗55例，非手术组均治愈，手术组死亡率为3．63％(2，55)。结论 腹腔手术是形成粘连性肠梗阻的主要因素，诊断主要靠病史、体征及腹部X线摄片检查，螺旋CT扫描和腹部B超检查对明确梗阻部位及肠绞窄趋势有重要意义。粘连性肠梗阻非手术治疗成功率高，而出现肠绞窄及肠坏死时应积极手术，掌握粘连性肠梗阻时机十分重要。     

MSCT诊断粘连性肠梗阻绞窄

目的 探讨MSCT对粘连性肠梗阻绞窄的诊断价值。方法 回顾性分析经手术及病理证实的70例粘连性肠梗阻患者的MSCT征象,评价其对发生绞窄的诊断价值。结果 70例粘连性肠梗阻,手术及病理确诊34例发生绞窄,MSCT诊断29例发生绞窄,其中26例有既往腹部手术史。MSCT征象中,肠壁强化程度减低、弥漫性肠系膜水肿及血管增粗、肠系膜积液、肠壁增厚、C/U型肠襻与粘连性肠梗阻绞窄有关（P均<0.05）。MSCT诊断粘连性肠梗阻绞窄的敏感度85.29%（29/34）,特异度100%（36/36）,准确率92.86%（65/70）。结论 MSCT对判断粘连性肠梗阻绞窄具有较高价值。     

腹内疝CT征象5例临床分析

目的:探讨腹内疝的螺旋CT表现,以提高其诊断率.方法:回顾性分析5例腹内疝的临床及CT表现.结果:5例术前CT检查有4例表现为小肠梗阻,CT表现为肠袢异常聚集和包裹,具有相应占位征象;肠系膜血管异位、伸拉、聚集;肠管梗阻位置多样;当疝入肠管绞窄坏死时出现肠壁水肿,强化程度减轻,肠系膜水肿呈"梳征".结论:多层螺旋CT及三维重建有利于腹腔内疝的定位及定性.     

肠脂肪酸结合蛋白在成人粘连性绞窄性肠梗阻中的变化及临床意义

目的探讨血清肠脂肪酸结合蛋白(IFABP)浓度在成人粘连性绞窄性肠梗阻中的变化及临床意义。方法纳入我院普外科急诊收治的粘连性绞窄性肠梗阻并于入院后及时行手术解除梗阻的患者36例,同期收治的单纯性粘连性肠梗阻患者46例做对照。所有患者于入院时抽取静脉血,绞窄性肠梗阻患者术前与术后第一天再次抽取静脉血,均采用双抗体夹心酶联反应(ELISA)检测IFABP浓度。结果入院时绞窄性肠梗阻患者血清中IFABP含量明显高于非绞窄组,差异有统计学意义(P<0.05);绞窄组在入院、术前及手术解决梗阻后患者血清中IFABP的浓度均有明显变化(P<0.05)。结论 IFABP可以作为判断粘连性肠梗阻患者是否发生肠绞窄或肠坏死的辅助诊断依据。     

螺旋CT诊断急性肠梗阻46例分析

目的：探讨螺旋CT在急性肠梗阻中的诊断应用。方法：收集46例经手术和临床综合诊断证实的急性肠梗阻病例的CT表现进行回顾性分析。结果：CT显示扩张肠袢和萎陷肠段间移行区是梗阻的可靠征象。近段肠腔扩张越明显,远端结肠积气越少,越提示急性完全性肠梗阻;梗阻肠壁增厚,延时强化及系膜密度增高,血管模糊,是绞窄性肠梗阻十分重要的征象。结论：螺旋CT在评价急性肠梗阻方面有较高的应用价值。     

37例老年绞窄性肠梗阻诊治体会

我院外科1980年以来收治60岁以上老年绞窄性肠梗阻37例,男性22例,女性15例。75岁以上5例。梗阻原因:嵌顿疝6例,肠扭转10例,粘连带致绞窄型肠梗阻16例,肿瘤5例(结肠)。治疗方式:行肠切除端端吻合9例,粘连松解加肠切除6例。粘连带分解解除梗阻复位22例。结果:死亡9例(包括病情     

腹部手术后腹内疝35例分析

目的:探讨腹部手术后腹内疝所致肠梗阻的诊断、治疗、病因及预防。方法:对35例经手术证实为腹内疝患者的临床资料进行回顾性分析。结果:腹部手术后腹内疝所致肠梗阻的临床特点是易绞窄,术前很少确诊,本组病例均有肠管血液循环障碍,肠坏死18例,穿孔1例,除1例因中毒性休克、多系统器官功能衰竭死亡外,余病例均痊愈。结论:腹部手术后腹内疝所致肠梗阻临床少见,常按粘连性肠梗阻治疗,术时多数出现肠绞窄、肠坏死改变。腹部手术后引起腹内疝主要原因是腹内粘连物粘连后局部有裂隙形成,或腹部手术后局部遗漏未修复的裂隙致腹内疝发生。早期诊断、早期手术治疗是治愈的关键。     

肠梗阻的影像学诊断

目的探讨X线腹部平片和CT检查在肠梗阻诊断中的价值。方法搜集近年来514例肠梗阻病例,其中46例经手术治疗,平均年龄51．6岁,对x线腹部平片及CT影像学表现进行比较：分析梗阻是否存在、梗阻部位、病因的推断、梗阻程度的判断及有无绞窄性梗阻。结果46例经手术证实病例中,机械性梗阻45例（含绞窄性梗阻12例）,误诊3例。其中小肠梗阻23例,结肠梗阻21例,2例伴有肠穿孔：结论x线腹部平片与CT是诊断肠梗阻的有效方法,CT检查对梗阻病因、部位、类型的判断有其明显优势,尤其是绞窄性梗阻时肠系膜的变化有其较明显特征,是减少误诊的必要手段     

CT对急性成人肠套叠的临床诊断价值

目的探讨急性成人肠套叠的CT征象及临床诊断价值.方法对手术及病理证实的42例急性成人肠套叠行常规全腹CT平扫.结果小肠型肠套叠17例(40%);小肠-结肠套叠15例(36%);结-结型肠套叠10例(24%).直接征象有"靶征"22例、彗星尾征或肾形征20例.间接征象包括肠壁增厚18例,近侧肠腔不同程度的扩张19例,肠梗阻7例,邻近肠系膜或筋膜浸润3例等.结论 CT扫描对急性成人肠套叠的诊断、治疗有重要的指导作用.     

胎儿肠梗阻的MRI诊断

目的观察胎儿期肠梗阻MRI表现,结合生后手术史及病理学诊断,探讨MRI对胎儿期肠梗阻的诊断价值。材料与方法回顾性分析胎儿期肠梗阻病例26例,胎龄为孕23~35 w,均先行胎儿超声检查后再行胎儿MRI平扫。采用2D快速平衡稳态进动序列(2D fast imaging employ steady acquisition,2D FIESTA)、单次激发快速自旋回波(single-shot fast spin echo,SSFSE)序列、快速反转恢复运动抑制序列T1WI(fast inversion recovery motion insensitive T1WI,FIRM T1WI)和弥散加权成像(diffusion weighted imaging,DWI)序列。根据梗阻部位、梗阻区肠管信号改变、梗阻远端肠道充盈情况、肠系膜血管异常等进行影像学诊断,并观察继发改变如腹水、羊水增多等,随访出生情况及手术治疗结果,分析MRI诊断的正确率及漏诊率,探讨MRI各序列在胎儿肠梗阻诊断中的优势。结果 26例肠梗阻胎儿中:十二指肠/空肠狭窄或闭锁16例,其中4例伴十二指肠和空肠旋转不良;胎粪性小肠梗阻4例,其中2例继发肠扭转致肠缺血坏死;肛门闭锁4例;结肠狭窄或闭锁1例;先天性巨结肠1例。所有胎儿均伴有不同程度羊水增多,部分病例伴腹水、心包积液及睾丸鞘膜积液;2例为单脐动脉。MRI诊断正确率为92.3%(24/26),误诊率为7.7%(2/26)。MRI能清楚显示胎儿肠梗阻部位,观测肠管扩张的程度。SSFSE序列可显示系膜血管受累,FIRM T1WI序列有助于结肠梗阻的诊断,DWI序列可提示梗阻肠管缺血和出血的改变。结论胎儿期肠梗阻MRI图像有特征性改变,可以判断受累肠管的发生部位、梗阻程度和合并症等,对产前诊断和出生后手术治疗有重要参考价值。     

Small bowel obstruction secondary to Crohn disease

We investigated the computed tomographic (CT) findings in patients with small bowel obstruction (SBO) and Crohn disease (CD). Fourteen patients, seven men and seven women (mean age, 41.3 years), were retrospectively reviewed. All presented with clinical symptoms and signs of SBO. Eleven had a history of CD, whereas three experienced the bowel obstruction as the first manifestation of the disease. On CT, features of complete SBO were seen in nine patients, whereas incomplete obstruction was found in the other five. One patient had CT findings of an adhesive obstruction. The other 13 were diagnosed as having CD-related SBO; a markedly stenotic bowel segment caused the obstruction in one patient, and a thickened-wall small bowel segment with luminal narrowing was evident at the transition zone in the other 12. The mural thickening had a target appearance in seven and homogeneous thickening in the other five. Additional thickened bowel segments were found in five patients and mesenteric involvement was found in 10. Five patients were treated conservatively, and the other nine underwent surgery (one with adhesiolysis only). Resection of the stenotic bowel was performed in six patients and stricturoplasty was done in the other two, with associated intestinal biopsy in one of these two patients. Histopathology revealed findings of active on chronic disease in all. CT is frequently performed for suspected SBO, so radiologists should be aware of the diagnosis of CD, because SBO may be its first manifestation. Alternatively, radiologists can accurately diagnose a CD-related obstruction in a patient with known CD and differentiate it from an obstruction due to adhesions. Patient management in these cases, however, is based most often on the clinical condition.     

16排螺旋CT在急性肠梗阻诊断中的应用

目的 探讨16排螺旋CT在急性肠梗阻中的诊断价值.方法 回顾性分析经手术和临床诊断证实的36例急性肠梗阻患者的CT表现.结果 36例急性肠梗阻患者,CT报告梗阻部位正确33例,与临床结果对照符合率为91.7%;CT报告病因诊断正确29例,与临床结果对照符合率为80.6%,包括:粘连性梗阻13例,腹股沟疝2 例,肠扭转2 例,粪石性梗阻1例,胆石性梗阻2例,肠系膜血管栓塞2 例,小肠炎性病变1例,肠套叠2例,肠道肿瘤11例.结论 16排螺旋CT在评价急性肠梗阻方面有较高的应用价值.     

MSCT多平面重建技术在显示小肠梗阻移行带方面的价值

目的：探讨多层螺旋CT（MSCT）多平面重建技术对小肠梗阻移行带方面的价值.材料与方法：回顾性分析69例小肠梗阻患者的临床及MSCT资料,比较单纯轴位图像及联合多平面重建技术在小肠梗阻移行带的显示及病因等方面的差异.结果：69例中,MSCT均能正确诊断小肠梗阻,诊断率达100％.常规轴位图像和轴位图像联合多平面重建技术对移行带的显示率分别为75.36％、89.86％,二者间差异有统计学意义（P＜0.05）.二者对病因诊断正确率分别为72.46％、86.96％,差异具有统计学意义（P＜0.05）,轴位图像联合多平面重建技术对于粘连所致小肠梗阻诊断正确率优于单纯轴位图像.结论：轴位图像联合多平面重建技术在显示移行带及梗阻原因方面优于单纯轴位图像,能为临床治疗方案的制定提供依据.     

CT显示移行带在肠梗阻诊断中的价值

目的探讨CT检查对梗阻移行带的显示率，明确肠梗阻的病因。方法回顾性分析48例临床怀疑肠梗阻患者的临床资料及CT表现。所有病例均采用GE公司Highspeed NX/i螺旋CT行全腹部（自膈顶到耻骨联合）扫描，螺距=1，层厚8—10mm。16例静脉增强后扫描。2名高牟资放射科医师读片。移行区行5ram层厚／2．5mm间隔重建。结果48例不明原因肠梗阻患者中，CT诊断肠梗阻的43例．经手术及临床证实的有40例，CT诊断准确率93％，35例明确显示移行带，显示率81％。结论腹部CT检查能方便、有效地显示移行带，从而发现肠梗阻的梗阻部位、原因，为临床医生拟定治疗方案提供重要依据。     

CT diagnosis of small bowel obstruction: scanning technique, interpretation and role in the diagnosis

Intestinal obstruction is a relatively common condition with diagnosis based on the clinical signs, patient history, and radiographical findings. Once suspected, its presence should be determined and if present, the site and cause of obstruction, and presence of strangulation should be assessed for the appropriate patient management. With the recent technological developments, the role of computed tomography (CT) in the diagnosis of bowel obstruction has expanded. The examination should be performed with intravenous contrast administration and thinner sections and multi-planner image reformation are recommended to evaluate a site of particular interest. CT is reported to have a sensitivity refer to detection of a small bowel obstruction at over 90% for complete or high-grade obstruction and to disclose causes of obstruction in 70% to 95% of cases. CT also provides characteristic findings indicating the presence of closed-loop obstruction and intestinal ischemia, which leads to appropriate and timely management for these emergent cases.     

Sonographic features of internal hernia.

OBJECTIVE: The purpose of this series is to describe the sonographic findings in 4 patients with intestinal obstruction due to internal hernia. METHODS: Four patients had clinical features of intestinal obstruction. Sonography was performed with broadband convex and linear array transducers in these patients. RESULTS: In all 4 patients, there were features of intestinal obstruction with a zone of transition between dilated and nondilated bowel. There was a cluster of crowded, compressed, and aperistaltic small-bowel loops, as if they were tightly packed within a sac, by the side of this zone in 3 patients. This appearance was due to obstruction of the afferent loop caused by compression. In the last patient, there were 2 loops of dilated bowel within a sac outlined by fluid due to obstruction of the efferent loop. All 4 patients had obstructed internal hernias at laparotomy. CONCLUSIONS: Sonographic features of internal hernia are described.     

术后早期炎性肠梗阻36例诊治体会

目的：探讨术后早期炎性肠梗阻的特点及诊治原则。方法：分析36例术后早期炎性肠梗阻的临床资料。结果：36例经胃肠减压，营养支持。应用生长抑素和肾上腺皮质激素等治疗后均治愈。结论：（1）术后早期炎性肠梗阻多发性在术后5-7d；（2）有典型的肠梗阻症状和体征，但很少发生肠绞窄 ；（3）多为腹腔内炎症致广泛肠粘连引起。（4）应先试行保守治疗。其疗效满意。