多层螺旋CT对肠管及系膜钝挫伤的诊断价值

目的 探讨肠管及系膜钝挫伤（Blunt bowel and mesenteric injuries,BBMI）的多层螺旋CT（Multi-slice spiral computed tomography,MSCT）征象，分析判断BBMI的特征性CT表现，以利于提高诊断准确率，为临床治疗提供指导。方法 收集四川大学华西医院自2014年1月-2015年12月间经手术证实为腹部钝挫伤的患者83例，并对该83例患者行MSCT平扫、增强双期扫描及MPR重建。对照分析肠管及系膜钝挫伤的MSCT征象，计数资料统计采用卡方检验，比较各征象在组间的分布差异（P＜0.05，有统计学意义），诊断学指标包括各征象的敏感性、特异性、阳性似然比、阴性似然比和准确性，找出有助于诊断BBMI的CT征象。结果 本研究中发现下列9个CT征象的分布差异有统计学意义（P＜0.05），其诊断肠管及系膜钝挫伤的敏感性及特异性较高，这些征象包括腹腔及腹膜后积气，肠壁增厚，肠壁强化，肠壁不连续，气粪外溢征，系膜间积气，系膜间及肠袢间积液，系膜区血肿，系膜肿胀（系膜束征）。结论 MSCT在诊断肠管及系膜钝挫伤中有很重要的价值，能为临床是否需要急诊手术提供指导，从而减少并发症，降低死亡率。系膜血管珠状征及双面征一旦出现，应警惕有系膜血管损伤及肠壁破裂的可能。

Diagnostic value of MSCT in the diagnosis of bluntbowel and mesenteric injuries

To discuss the signs of Blunt bowel and mesenteric injuries ( BBMI) on multi － slice spiral computed tomography ( MSCT) ，and to analyze and identify the characteristic signs of BBMI to assist in improving the correct diagnosisrate as well as guide the clinical treatment. Methods This retrospective study collected eighty － three patients in West China Hospital of Sichuan University between January 2014 and December 2015. 83 blunt abdominal trauma patients were confirmed by surgical intervention，underwent MSCT，two － phase enhanced CT scanning and MPＲ. Intraoperative findings were compared with MSCT findings. The sensitivity，specificity，positive likelihood ratio，negative likelihood ratio，and accuracy were calculated，Chi － squared test was used in the study to help determine the CT signs of BBMI ( P ＜ 0. 05，Statistical significance) in two groups. Ｒesults 9 CT signs had statistical significance as well as a relatively higher sensitivity and specificity were as follows: Intra － or retro － peritoneal air，bowel wall thickening，bowel wall contrast － enhanced，bowel wall discontinuity，excrement overflow sign，mesenteric air，mesenteric fluid or interloop fluid，mesenteric hematoma，mesenteric stranding ( mesenteric fasciculation sign) . Conclusion Multi － slice spiral CT has a very important value in the diagnosis of Blunt bowel and Mesenteric injuries. These CT signs can help diagnose the intestinal and mesenteric blunt trauma，provide clinical guidance for the need of emergency surgery to reduce complications and mortality. Once Janus sign and mesenteric vessel beading sign happen，the possibility of mesenteric vascular injury and intestinal wall rupture should be alerted.