多层螺旋CT在肠梗阻诊断中的临床应用

目的 探讨多层螺旋CT及重建技术在肠梗阻的诊断及其临床上的应用价值.方法 对浙江丽水市中心医院2003年4月至2008年10月419例经临床诊断或手术病理确诊的各类型肠梗阻患者进行回顾性研究,并对CT表现进行分析.结果 419例患者CT诊断是否存在肠梗阻均与最终结果 相符合,而腹部平片诊断符合率为60.5%(237/392).对419例肠梗阻病因诊断结果 中,CT诊断符合率分别为肠粘连88.6%(117/132),肿瘤98.2%(112/114),腹内、外疝93.5%(43/46),肠套叠97.4%(37/38),炎症(包括7例炎症引起的麻痹性肠梗阻)83.3%(30/36),肠腔内异物88.5%(23/26),肠扭转90.9%(10/11),外伤(包括血肿压迫)62.5%(5/8),血运性肠梗阻100.0%(6/6),先天性中肠旋转不良100%(2/2);CT对梗阻病因诊断总体敏感性92.8%(389/419),准确性为91.9%(385/419),假阳性为1.0%(4/419),假阴性为7.2%(30/419).结论 多层螺旋CT检查能确诊肠梗阻,并且能明显提高对梗阻部位、梗阻程度、有无闭袢和绞窄及对梗阻原因的正确诊断率.

Clinical application of MSCT in diagnosis of intestinal obstruction

Objective To investigate the role of various multiple slice computed tomography (MSCT) and its reconstruction techniques in diagnosing intestinal obstruction(IO). Methods 419 cases diagnosed as IO by MSCT and proved by opereations or follow up were analysed ,retrospectively. Result As to the presence diagnosis of IO, in all the patients, CT diagnosis was consistent with the final results, while X-ray plain film had an accuracy of only 60. 5% (237/392). The causes of IO included adhesion 88. 6% (117/132), neoplasm 98.2% (112/114), external or internal hernia 93.5% (43/46), intussusception 97. 4% ( 37/38) , inflammatory disease (including 7 cases paralytic ileus, 83.3%, 30/36 ), enterolith 88. 5% (23/26), bowel torsion 90. 9% (10/11), trauma 62. 5% (5/8) , ischemia 100% (6/6), congenital lesion (100% ,2/2). Total sensitivity of etiology diagnosis with CT was 92. 8% (384/419), with accuracy , false positive and false negative to be 91.9% (385/419), 1.0% (4/419) and 7.2% (31/419), respectively. Conclusion MSCT can correctly diagnose the presence of the ileus, as well as can obviously enhance the accurate rate of diagnosis of its causes and characteristics, position, existence of close-loop and strangulation.