MSCT在胃肠道穿孔中的诊断价值

【摘要】〓目的〓探讨多层螺旋CT(MSCT)在胃肠道穿孔中的诊断价值。方法〓回顾性分析25例经手术和病理证实胃肠道穿孔患者的术前MSCT影像资料,进行多平面重建(multiplanar reformation,MPR),分析穿孔征象,定性及定位的诊断准确性。结果〓25例患者中,胃、十二指肠穿孔18例,空、回肠穿孔2例,结肠穿孔3例,阑尾穿孔2例。MSCT术前诊断穿孔的正确率为100%(25/25),定位诊断正确率为96%(24/25)。CT诊断胃肠道穿孔的直接征象为肠壁连续性中断12例(48%)。间接征象包括腹腔内游离气体23例(92%),穿孔部位周围的炎症渗出改变25例(100%),腹腔积液12例(48%),局部胃肠道管壁增厚13例(52%),小网膜囊积液3例(12%),阑尾周围脓肿2例(8%),弥漫性腹膜炎2例(8%)。结论〓MSCT对胃肠道穿孔的定性和定位具有很高的诊断价值,有助于外科手术治疗。

Diagnosis values of multi-slice CT in gastrointestinal tract perforation

【Abstract】〓Objective〓To evaluate the diagnostic value of multi-slice spiral CT (MSCT) in gastrointestinal tract perforation..Methods〓MSCT findings of 25 patients with surgically and patholo-gically proved gastrointestinal tract perforation were reviewed retrospectively..Multiplanar reformation was performed in all patients..The imaging signs,.diagnosis and localization capability of MSCT were analyzed..Results〓Among the 25 patients,.perforation of stomach/duodenum were found in 18 patients,.jejunoileum in 2 patients,.colon in 3 patients,.appendix in 2 patients..The presence of perforation was correctly diagnosed in 100% (25/25) of the patients on MSCT,.and perforation location was correctly diagnosed in 96% (24/25) of the patients before surgery..CT direct sign of perforation was discontinuity of gastrointestinal wall.in 12 patients (48%)..Indirect signs of perforation included intraperitoneal free air in 23 patients(92%), inflammation change around the perforated site in 25 patients(100%), ascites in 12 patients (48%), thickening of the gastrointestinal wall in 13 patients (52%), lesser sac effusion in 3 patients (12%), appendix abscess in 2 patients (8%), diffuse peritonitis in 2 patients (8%). Conclusion〓MSCT is of high value for correct diagnosis of gastrointestinal perforation and detecting the perforation location, and helpful for surgical treatment.