多层螺旋CT对不同病因下腹腔游离气体症的诊断价值

目的：评价多层螺旋CT (MSCT)对不同病因下腹腔游离气体症的诊断价值。方法回顾性分析我院2010年1月至2015年12月收治的41例经手术病理证实有腹腔游离气体患者的临床资料及影像学表现。结果41例患者中非消化道穿孔合计5例，其中肝脓肿破裂2例，子宫脓肿破裂3例；消化道穿孔合计36例，其中胃溃疡穿孔6例，十二指肠溃疡穿孔18例，胃癌穿孔3例，结肠癌穿孔2例，乙状结肠炎症坏死穿孔1例，回肠溃疡穿孔1例，胃、小肠及小肠及结肠复合伤穿孔3例，结肠癌术后吻合口狭窄肠镜扩张术及息肉摘除术穿孔各1例，腹腔均见到游离气体影。非消化道穿孔表现为腹腔游离气体量较少，病变处脓肿及其相邻包膜破裂。消化道穿孔表现为腹腔游离气体量较多，消化道病变处不连续。结论非消化道穿孔与消化道穿孔影像学表现有一定差异，多层螺旋CT有助于对不同原因腹腔游离气体定性、定位诊断。

Diagnostic value of multi-slice CT in free intraperitoneal air of different etiologies

Objective To evaluate the diagnostic value of multi-slice CT (MSCT) in free intraperitoneal air of different etiologies. Methods The clinical data and imaging findings of 41 cases of free intraperitoneal air confirmed by operation in our hospital from January 2010 to December 2015 were analyzed retrospectively. Results Among the 41 patients, there were 5 cases of non-gastrointestinal perforation (including 2 cases of rupture of liver abscess, 3 cases of uterine abscess rupture) and 36 cases of gastrointestinal perforation (including 6 cases of gastric ulcer perforation, 18 cases of duodenal ulcer perforation, 3 cases of gastric cancer perforation, 2 cases of colon cancer perforation, 1 case of sig-moid colon perforation of inflammatory necrosis, 1 case of ileal ulcer perforation, 3 cases of perforation of stomach, small intestine and colon injury, 1 case of dilatation for anastomotic stricture after colorectal cancer and 1 case of perforation af-ter endoscopic polypectomy). All patients were examined by MSCT and manifested free intraperitoneal air in different sites. Non-gastrointestinal perforation showed less amount of free intraperitoneal air, lesion abscesses, and rupture of adja-cent capsule. Gastrointestinal perforation showed more free intraperitoneal air and discrete lesion. Conclusion There are some different imaging characteristics between non-gastrointestinal perforation and gastrointestinal perforation. MSCT is helpful to the diagnosis of free intraperitoneal air of different etiologies.