MSCT对肠系膜非肿瘤性病变的诊断

目的探讨多层螺旋CT（MSCT）对肠系膜非肿瘤性病变的诊断价值。方法回顾性分析经手术病理及随访观察证实的84例肠系膜非肿瘤性病变的CT表现与诊断,其中72例经穿刺／手术病理证实,其余按照CT标准做出诊断。应用GE LightSpeed Pro16CT机进行腹部平扫和双期增强扫描,并采用1．25mm层厚和1mm重建间隔在ADW4．2工作站获取最大密度投影（MIP）和多平面重建（MPR）图像,评价不同病变时肠系膜及其血管及邻近脏器的改变。结果84例中：肠系膜水肿30例,其中肝硬化所致10例,肾衰所致4例,门脉、肠系膜上静脉栓塞4例,肠系膜上动脉栓塞4例,肠系膜扭转4例,肠系膜上静脉、门脉广泛积气2例,肠脂垂炎2例;炎性渗出34例,其中胆囊炎、阑尾炎、附件炎各6例。胰腺炎、升结肠憩室炎2例,肠系膜脓肿4例,肠穿孔5例,淋巴结炎3例：肠系膜血管挫伤10例,其中4例合并肠破裂;其他病变10例,包括脂肪沉积2例,肠系膜脂膜炎8例。肠系膜非肿瘤性病变的主要MSCT表现：肠系膜密度增高82例,其中弥漫性发布39例,节段性分布43例,表现为肠系膜雾状线条状增高即云雾状肠系膜。肠间隙内积液37例,9例同时伴积气。环绕肠系膜根部的脂肪肿块样改变8例,肠系膜增厚呈缆绳样改变2例,肠系膜旋转4例,肠系膜血管内对比荆缺损8例、积气2例,肠系膜上动脉增粗4例。3例淋巴结炎表现为回盲部多发小结节,边缘模糊。结论常见的肠系膜非肿瘤性病变病种多、表现相近,大部分具有特征性的cT表现,必须结合病史,方可提高定性诊断符合率。     

肠系膜脂膜炎误诊为结肠肿瘤病4例分析报道

目的探讨肠系膜脂膜炎误诊结肠肿瘤的原因和教训.方法对4例肠系膜脂膜炎患者的临床资料进行回顾性分析.结果 4例术前均误诊为结肠肿瘤.结论肠系膜脂膜炎术前确诊率低,鉴别诊断复杂,在临床上应予以重视.     

多层螺旋CT对肠系膜原发非肿瘤性病变的诊断价值

目的:探讨多层螺旋CT(MSCT)对肠系膜原发非肿瘤性病变的诊断价值。方法:回顾性分析经手术病理及随访观察证实的44例肠系膜原发非肿瘤性病变的CT表现与诊断,其中34例经穿刺/手术病理证实,其余按照CT标准做出诊断。应用GE LightSpeed Pro 16 CT机进行腹部平扫和双期增强扫描,并采用1.25 mm层厚和1 mm重建间隔在ADW4.2工作站获取最大密度投影(MIP)和多平面重建(MPR)图像,评价不同病变时肠系膜及其血管及邻近脏器的改变。结果:44例中肠系膜水肿17例,包括门脉、肠系膜上静脉栓塞4例,肠系膜上动脉栓塞4例,肠系膜扭转4例,肠系膜上静脉、门脉广泛积气2例,大网膜梗死1例,肠脂垂炎2例;炎性渗出7例,包括肠系膜脓肿4例,淋巴结炎3例;肠系膜血管挫伤10例,其中4例合并肠破裂;其他病变10例,包括脂肪沉积2例,肠系膜脂膜炎8例。肠系膜原发性非肿瘤性病变的主要MSCT表现:肠系膜密度增高42例,其中弥漫性发布23例,节段性分布19例,表现为肠系膜雾状线条状增高即云雾状肠系膜。肠间隙内积液12例,4例同时伴积气。环绕肠系膜根部的脂肪肿块样改变8例,肠系膜增厚呈缆绳样改变2例,肠系膜旋转4例,肠系膜血管内对比剂缺损8例、积气2例,肠系膜上动脉增粗4例。3例淋巴结炎表现为回盲部多发小结节,边缘模糊。结论:常见的肠系膜原发性非肿瘤性病变种类多、表现相近,大部分具有特征性的CT表现,必须结合病史,方可提高定性诊断符合率。     

A case of phlebosclerotic colitis with involvement of the entire colon

Phlebosclerotic colitis is a rare type of ischemic colitis caused by obstruction of the veins in the intestinal wall and adjacent mesentery, and is most commonly seen in the ascending colon. We report a 56-year-old woman presenting with intermittent abdominal pain and diarrhea for three years. She had a liver abscess and two episodes of pancreatitis during this time and experienced progressive body weight loss. Initial radiologic findings showed multiple tortuous threadlike calcifications in the region of the right side of the colon and transverse colon on plain abdominal radiographs and computed tomography images. A colonoscopy demonstrated brownish-black pigmentation on the right side of the colon with scattered hyperemic patches. The more distal along the colon, the more normal the color of the bowel appeared. Follow-up studies revealed calcifications not only alongside the colonic and mesenteric veins, but also extending into the superior and inferior mesenteric veins. These findings have not been reported previously. As noted in our patient, this disease entity may not be confined to the tributaries of the superior mesenteric vein. The entire colon may be involved in advanced disease.     

选择性肠系膜动脉造影诊断下消化道出血性病变

对18例疑为下消化道出血的患者作选择性肠系膜动脉造影,发现小肠平滑肌瘤2例、小肠血管发育异常2例、非闭塞性肠系膜血管梗塞症2例、回盲部和升结肠恶性淋巴瘤各1例、结肠腺癌3例以及乙状结肠息肉1例。本文对其中3例典型病例作了介绍,还对选择性肠系膜动脉造影诊断下消化道出血的价值、造影片上各类出血性病变的鉴别诊断及如何提高阳性诊断率等问题进行了讨论。     

An unusual abdominal tumor--leiomyosarcoma of the mesentery: a case report

We report the case of an 82-year-old woman who presented with an ill-defined mass and tenderness in the right lower quadrant of the abdomen. On computerized tomography scan, she had an irregular large bosselated mass of the mesentery located medial to the cecum and associated with multiple loops of small intestine. Preoperative differential diagnoses included leiomyosarcoma, lymphoma and gastrointestinal stromal tumor. The mesenteric mass was resected and identified as a leiomyosarcoma. This patient's tumor is typical of a mesenteric leiomyosarcoma and recurred with hepatic metastases two years after its initial removal. Such tumors usually do not become symptomatic until late in the course of disease, often after distant metastases have occurred. Mesenteric leiomyosarcomas are rare and have a reported incidence of 1: 350,000.     

多层螺旋CT对儿童肠重复畸形的诊断价值简

目的探讨多层螺旋CT对儿童肠重复畸形的诊断价值。方法回顾性分析2O例经手术病理证实的肠重复畸形CT表现。结果本组20例肠重复畸形中,位于胃底部1例、十二指肠2例,空肠1例,回肠13例,升结肠及降结肠各1例,膀胱1例。19例嫡变位于肠系膜侧,1例位于系膜对侧。1例病变与升结肠问可见细蒂相连呈憩室型改变,1例与降结肠伴行呈管状,余18倒均为囊肿型。1例合并畸胎瘤,1例合并肠套叠、3例合并肠扭转。结论多层螺旋CT具有较高的密度分辨力,结合后处理三重建技术,可对儿童肠重复畸形的诊断提供重要信息。     

肠缺血中肠系膜及其血管的MDCT表现

目的探讨肠缺血中肠系膜及其血管的多层螺旋CT表现与诊断价值。方法回顾性分析28例肠缺血患者的肠系膜及其血管的多层螺旋CT平扫和增强表现,所有病例经手术、临床病理或DSA造影证实。结果CT表现：肠系膜水肿18例,肠系膜积气2例,肠系膜血管走行异常7例,肠系膜血管充盈缺损5例,肠系膜主干血管增粗2例,节段性肠系膜小血管充血21例,节段性肠系膜小血管缺血7例,肠系膜静脉积气2例。另可见其他表现：肠壁增厚25例,肠管扩张26例．肠腔大量积液23例．肠壁异常强化25例,肠管形态异常10例．肠壁积气3例,腹水和气腹12例。结论肠系膜及其血管的CT改变是诊断肠缺血的重要依据,CT检查具有重要的价值,并可提示肠缺血的原因。     

Mesenteric panniculitis. Imaging of a rare cause of chronic abdominal pain

We report a case of mesenteric panniculitis. This rare and poorly-known disease is characterized by a nonspecific inflammatory process involving the adipose tissue of the mesentery. This case illustrates its computerized tomographic and magnetic resonance imaging features and the value of imaging in differentiating it from other mesenteric diseases and thus, avoiding unnecessary surgery.     

肠及肠系膜损伤的CT表现

目的探讨肠及肠系膜损伤的CT表现特点。方法12例经手术证实的肠及肠系膜损伤病例，主要观察（1）肠管破裂，腹腔游离气体的分布特点。（2）腹膜腔内游离积液的密度、腹水聚集部位与肠及肠系膜损伤部位的关系。（3）肠及肠系膜改变的CT表现形式。结朵（1）手术发现肠管不同程度穿孔、撕裂5例，4例腹腔内肠管外可见游离气体；1例空肠小穿孔，CT未发现腹腔游离气体；气体的多少与肠管破裂部位及裂口大小有关。（2）腹腔内游离积液12例，腹水密度较高（〉35HU），损伤部位肠间积液9例。（3）肠管改变，肠壁增厚、肠管扩张、连续层面肠管的连续性中断。（4）肠系膜水肿，较广泛或局限性肠系膜脂肪密度增高，见条状影，系膜间见大小不等血肿影（〉50HU）。结论腹腔肠管外游离气体、密度较高游离积液、肠间积液、肠系膜密度改变，常可做出肠及肠系膜损伤的可靠CT诊断。     

Clinical experience of diagnosis and treatment for 8 cases with acute abdomen caused by mesenteric vascular lesions

Mesenteric vascular lesions may result in a-cute abdomen due to ischemia of intestine and hem-orrhage in abdominal cavity.As the increased age-ing of population and progress in diagnosis of vas-cular diseases,the incidence of these diseases in-creases gradually and their mortality ratesare quitehigh[1～ 3 ] . Now,in order to understand themdeeply,we analyzed8cases with mesenteric vascu-lar lesions in our hospital.1　 Clinical dataSince 1 980 's,8cases were confirmed surgical-ly and pathologica…     

肠系膜囊性淋巴管瘤的CT诊断及文献复习

目的：探讨肠系膜囊性淋巴管瘤的CT表现。方法：回顾性分析我院经手术病理证实的7例肠系膜囊性淋巴管瘤CT资料及文献复习。结果：单房囊肿3例，多房囊肿4例，囊壁菲薄、光滑，有分隔2例，7例均密度均匀。手术病理证实圆肠系膜、网膜系膜及结肠系膜下各1例。结肠系膜及空肠系膜各2例。结论：肠系膜囊性淋巴管瘤是腹部少见囊性病变，多呈分叶状多房性薄壁囊肿。CT对肠系膜囊性淋巴管瘤的诊断和鉴别诊断有很高的临床应用价值。     

Congenital positional anomaly of descending colon and sigmoid colon: Its embryological basis and clinical implications

The rotation of the midgut is essential for normal placement of intestines in the abdominal cavity. The process of midgut rotation and simultaneous retraction of the herniated intestinal loops pushes the hind gut to the left side of the abdominal cavity. So the descending colon and the sigmoid colon occupy the left side of the abdominal cavity. In this report, we document a male cadaver that revealed right-sided sigmoid colon. On further dissection, the descending colon was found lying in the midline with a small peritoneal fold stretching from the right side of sigmoid colon to ileocecal junction. There was also variation in the inferior mesenteric artery supplying the displaced descending colon and sigmoid colon. The possible embryological and molecular basis of this variation has been discussed. The anatomical knowledge of this variation is essential for interventional and diagnostic colonoscopy procedures and colonic surgeries.     

多层螺旋增强CT结合血管重建技术对肠及肠系膜损伤的诊断价值

目的 探讨多层螺旋增强CT 结合血管重建技术对肠及肠系膜损伤的诊断价值。方法 回顾性分析86 例肠及肠系膜损伤（BMIs）患者的多层螺旋CT 增强扫描及血管重建的影像特征,评价多层螺旋CT 结合血管重建技术对肠及肠系膜损伤的诊断价值。结果 在86 例BMIs 患者中,单纯小肠损伤共35 例（40.7%）;小肠合并肠系膜损伤21 例（24.4%）;单纯结肠损伤共15 例（17.4%）;结肠合并小肠损伤5 例（5.8%）;结肠合并肠系膜损伤3 例（3.5%）;单纯肠系膜损伤7 例（8.2%）。多层螺旋CT 增强扫描及血管重建的主要表现为小肠或结肠肠壁增厚,肠管连续性中断;肠系膜损伤,肠系膜血肿形成,造影剂外渗;腹腔、盆腔及腹膜后积液（血）,腹腔内游离气体。结论肠及肠系膜损伤（BMIs）患者的MSCT 增强及CTA 影像表现具有特征性,对于BMIs 诊断具有较高的临床价值。     

多层螺旋CT对肠淋巴瘤的诊断价值

目的:探讨多层螺旋CT(MSCT)对肠淋巴瘤的诊断及临床价值。方法:12例肠淋巴瘤患者全部进行64层螺旋CT扫描,均经手术、病理证实。结果:病变位于小肠8例,结肠4例。MSCT见肠壁增厚12例,表现为局部明显软组织肿块4例;肠壁的环形浸润性增厚3例;肠系膜区肿块2例,呈"夹心面包征"或"三明治征;"2例同时发现肠壁的浸润增厚和肠系膜区肿块。病灶轻-中度强化,肠管仍保持一定的柔软度。12例病例中肠腔狭窄11例,"动脉瘤样扩张"1例。4例合并腹膜后淋巴结肿大。结论:MSCT扫描在肠淋巴瘤的诊断中具有独特的优越性,并能通过多方位重建(MPR)更清晰显示病灶特征,显著提高了病变的检出率和诊断准确率及对肿瘤的定位、定性诊断,有助于外科手术。     

双能量CT增强扫描对缺血性肠病的诊断价值

目的:探讨双能量CT(DECT)对诊断缺血性肠病的临床价值。方法:回顾性分析29例经临床证实的急性肠缺血患者的双能量CT表现。所有患者均行双源双能量CT增强检查,包括动脉期、门脉期、平衡期及虚拟平扫、后处理血管重建;24例行DSA检查及介入治疗;5例行肠部分切除手术。结果:应用DECT血管重建技术诊断肠系膜上静脉血栓形成12例、肠系膜上动脉栓塞9例、肠系膜上动脉狭窄7例、肠系膜上动脉痉挛1例。本组29例均获得外科手术或DSA介入诊疗证实。肠系膜动脉血栓形成时,肠壁可有强化相对减弱;肠系膜静脉血栓形成时,肠管管壁肿厚、肠系膜水肿、腹腔积液;肠壁气肿只见于全层坏死,而其它征象均可见于不同病因、不同程度的肠缺血。结论:DECT能准确诊断缺血性肠病的原因,并有助于判断缺血的程度,减少临床误诊误治。     

Mesenteric cysts — A series of six cases with a review of the literature

Background  Symptomatic mesenteric cysts account for only 1 in 100,000 acute adult and 1 in 20,000 acute paediatric admissions. Acute symptoms are related to compression of intra-abdominal organs or stretching of the mesentery by rapid expansion. An abdominal mass, mobile in transverse but not longitudinal plane, is often the only physical finding. Method  We outline the presentation, management and histological findings of 6 cases that presented to this hospital from 1987–1997. Results  There were 5 adults aged 32–79 yr and an 8 yr old boy. The child presented acutely with a painful tender abdominal mass. Of the adults, 1 presented acutely, 2 with chronic symptoms and 2 were incidental findings. Mesenteric cysts were successfully resected in all cases. Conclusion  Surgical intervention is recommended and resection of adjacent bowel may be necessary for complete excision. Successful minimal access surgery via the laparoscope has been reported and may become more widely applicable.     

Sonographic appearances of mesenteric cysts--report of 2 cases]

Mesenteric cyst is defined as a cystic mass located in the mesentery, and has rarely been reported. Before the clinical use of ultrasound (US), the imaging diagnosis of the abdominal mass depended on plain X-ray films and contrast examinations to delineate the space occupying lesion. The later use of US enables us to readily identify mass character. For example, whether it is cystic or solid, with or without septum, or whether there is sediment in the cyst. US examination is the method of choice in evaluating abdominal masses. Two cases of pediatric mesenteric cysts were brought to our hospital on account of complication. US of the first patient revealed a huge cystic mass with sediment and septae in central abdomen. Mild hydronephrotic change of the right kidney was found. The pathology showed nonepithelial lining multiloculated cyst surrounded by a thick, fibrotic granulomatous wall with suppurative cell infiltration and some calcifications. The histopathological diagnosis was an infected pseudocyst. The other patient had a cyst which twisted the jejunum and resulted in intestinal obstruction. US found dilated intestinal loops and a septate cystic mass in epigastrium. The pathology showed a multiloculated cyst with mesothelial lining, representing a mesothelial cyst. Both patients were treated surgically and had an uneventful recovery. In this article we described and explained the findings on US, discussed the differential diagnoses and compared different imaging modalities.     

外伤性急腹症应用腹腔镜治疗21例体会

目的 探讨腹腔镜在外伤性急腹症中的应用价值.方法 对21例外伤性急腹症的患者进行腹腔镜探查和治疗.其中肝破裂修补4例,脾破裂修补2例,脾切除3例,胃穿孔修补2例,肠穿孔修补2例,小肠部分切除1例,横结肠系膜血管结扎止血1例,横结肠修补1例,单纯探查引流2例,中转开腹手术3例.结果 21例全部治愈,并发症5例(穿刺孔感染2例,腹腔积液3例).手术时间为30～250mln,住院时间7～28d.结论 外伤性急腹症应用腹腔镜探查及手术具有明显优越性,但应严格掌握适应证,并根据病情及操作者的能力及时决定是否中转开腹.     

原发性小肠肿瘤93例临床分析

目的 探讨小肠肿瘤类型、临床特点及其诊断。方法 回顾性病例分析。结果 小肠良性肿瘤中以平滑肌瘤为多,占12/17;恶性肿瘤中以腺癌多见,占45/76。小肠肿瘤可表现为消化道出血、腹痛、腹块、发热、黄疸等。上消化道钡餐（GI）检查28例,21例阳性;9例行动脉造影,手术证实病变部位与造影一致。结论 动脉造影对小肠肿瘤有定性定位诊断价值,逆行胰胆管造影（ERCP）、CT也有一定的诊断价值。