慢性血吸虫病腹部CT及病理对照研究

目的 回顾分析慢性血吸虫病腹部CT表现与病理结果，以求进一步提高对其的诊断准确性。方法 103例患者进行腹部CT平扫，81例行CT增强扫描；全部病例均获得手术标本及作病理切片，并注意切片方向与CT扫描层面相近的平面进行。结果 CT显示肝硬化84例，以肝脏右叶改变最重；肝内不同形态钙化71例，以分隔状钙化最多；肝癌12例；脾脏增大78例，脾脏钙化13例；结肠壁增厚27例，以降、乙状结肠及直肠增厚居多；结肠壁钙化31例，其中全结肠弥漫性钙化5例；结肠癌9例。病理观察肝内不同程度纤维化并形成假小叶，纤维增生间隔及假小叶内均可见虫卵及钙化；结肠黏膜下及区域淋巴结内可见虫卵及钙化。结肠壁纤维组织及黏膜组织增生明显；脾内可见纤维增生及钙化，但未见虫卵。结论 慢性血吸虫病对腹部脏器的损伤以肝脏及结肠为重，CT的病理性改变也相对明显，而脾脏改变大多是肝硬化的伴随变化。CT腹部扫描检查是慢性血吸虫病脏器病理损害和程度的重要影像诊断方法。

Comparison of abdominal CT and pathological findings in chronic schistosomiasis

Objective To retrospectively analyze the abdominal CT findings and pathological results of the chronic schistosomiasis so as to improve the diagnostic accuracy of the disease. Methods The plain abdominal CT scanning was performed in 103 cases and enhanced CT scanning in 81 cases. The pathological specimen which was consistent with the section of CT scan was obtained in each cases. Results On CT scanning, liver cirrhosis was seen in 84 cases, various calcification in liver in 71 cases, liver cancer in 12 cases, enlargement of spleen in 78 cases, calcification in spleen in 13 cases, wall-thickening in colon in 27 cases, calcification in colon in 31 cases, and colon cancer in 9 cases. Pathological examination revealed various fibrosis and formation of pseudolobule. The eggs and calcification could be seen in pseudolobule and septa, colonic submucosa, and regional lymph nodes. Fibrous hyperplasia in colonic wall and hyperplasia in mucous membrane were obvious. Fibrous hyperplasia and calcification were seen in spleen, but the eggs were not found. Conclusion The liver and colon are the major organs affected by chronic schistosomiasis in abdomen, and the CT findings are obvious too. The pathological features of spleen are accompanied with liver cirrhosis. CT is the important imaging method in diagnosing chronic schistosomiasis and pathological changes.