基层医院多层螺旋CT对腹壁切口子宫内膜异位症的诊断经验

目的 初步评价多层螺旋CT（MSCT）诊断腹壁切口子宫内膜异位症的临床应用价值。方法回顾分析本区两个医疗单位自2002年1月-2012年12月,收治共28例手术治疗并术后病理确诊27例为腹壁切口子宫内膜异位症患者的多层螺旋CT（MSCT）影像资料,对结果进行分析。结果28例患者中确诊27例,其中23例表现为囊性型包块的CT表现为与临近器官组织紧密相连的囊性病变。CT值在30-50Hu。囊壁增强后有轻、中度强化。偶伴囊内出血时表现为局灶性高密度灶,出血伴液化后不强化。3例表现为囊实性包块CT表现为近器官组织紧密相连的囊实性病变,具有囊性肿物的大部分CT表现。2例表现为实性包块CT平扫表现为等密度实实性肿物质,边界清但边界欠光滑。增强扫描由于异位结节中有子宫内膜血管,肿块呈轻、中度均匀强化,偶伴出血,但此2例其中有1例术前诊断为腹壁切口子宫内膜异位症患者术后病理为腹壁纤维瘤。结论 与临床资料相结合,特征性螺旋CT表现结合典型临床症状,能准确作出腹壁切口子宫内膜异位症的诊断,而且对临床病灶的手术切除具有重要的指导价值;并且诊断迅速、操作简便、无创伤、可靠、可重复性强等优点,因此,多层螺旋CT（MSCT）是诊断腹壁子宫内膜异位症的一种确切有价值的方法。

Diagnostic experience of multi-slice spiral CT for abdominal incision en- dometriosis in primary hospital

Objective To preliminarily evaluate the clinical application value of Multi-slice spiral CT （MSCT） for di- agnosis of abdominal incision endometriosis. Methods Twenty eighty cases of operative treatment patients, among whom 27 cases were diagnosed abdominal incision endometriosis by postoperative pathologic in two medical units of our district from January 2002 to December 2012 were selected, and their MSCT image data and results of were ana- lyzed retrospectively. Results Among 28 cases, 27 cases were made definite diagnosis, among whom 23 cases mani- fested CT manifestation of cystic mass： cystic lesions were closely connected with the adjacent organs and tissues; the CT value was 30 to 50 Hu; after cyst wall enhancement had light, moderate enhancement; occasionally with intracystic hemorrhage, it showed focal high density lesions, there was no enhancement after hemorrhage combined with liquefied. 3 cases manifested CT manifestation of cystic solid mass： cystic solid lesions were closely connected with the adjacent organs and tissues; which had parts of the CT manifestations of cystic neoplasm. 2 cases manifested solid mass, the CT scan showed equidensite solid tumor, boundary clear but not smooth. Because of endometrial vascular in ectopic nod- ules, the enhancement scan showed that the mass had light, moderate homogeneous enhancement, occasionally com- bined with bleeding. Among the 2 cases, 1 c, ase was diagnosed abdominal fibroma by postoperative pathologic, who was misdiagnosed ahdominal incision endometriosis before surgery. Conclusion Combined with clinical data, charae-teristies spiral CT manifestation and typical clinical symptoms, can make abdominal incision endometriosis diagnosis accurately, which also had important guiding value for excision of clinical lesions. It has advantages of quick diagnosis, easy operation, noninvasive, reliable and reproducibilily, so MSCT is a value method for diagnosis of abdominal inci- sion endometriosis.