肠系膜血管栓塞致肠缺血的CT诊断

目的：分析肠系膜血管栓塞致肠缺血的CT表现，提高对本病的CT诊断水平。材料与方法：回顾性分析经临床及病理证实的13例肠系膜血管栓塞的CT平扫及增强表现。结果：10例患者表现出肠系膜血管栓塞直接征象：受累血管内见栓子，其中7例患者CT平扫即表现为系膜血管增粗，管腔密度增高或减低，1例患者因就诊较晚直接表现为系膜血管及门静脉内积气；2例患者CT平扫未见明显系膜血管病变，增强扫描表现为管腔充盈缺损；另3例患CT平扫系膜血管未见异常改变，剖腹探查术后病理证实为系膜血管栓塞。13例患者均表现出肠系膜血栓的间接征象肠缺血：其中11例表现为肠腔扩张积气积液；8例肠壁增厚；5例肠壁变薄；4例肠壁密度增高；2例肠壁积气；4例出现肠系膜水肿；1例系膜内积气；4例肠缺血并发腹膜炎出现腹水。结论：腹部CT检查尤其是增强扫描可直接显示肠系膜血管及其主要分支的管腔情况，对肠系膜血管栓塞致肠缺血具有很高的诊断价值，对不明原因的急性腹痛患者应作为首选检查方法。

CT Diagnosis of Intestinal Ischemia by Mesenteric Infarction

Purpose： To analyze the CT findings of intestinal ischemia by mesenteric infarction for improving the CT accuracy of diagnosis. Materials and Methods： Characteristic CT appearances of intestinal ischemia by metsenteric infarction verified by clinic and operation in 13 patients were retrospectively analysed. Results： The direct CT sign of intestinal ischemia by mesenteric infarction is the thrombus in mesenteric vessel were revealed in 10 cases. Among them 7 cases with plain scan showed mesenteric vascular enlarged with high or low density, one case directly showed portomesenteric venous gas, the other 2 cases showed filling defects by enhanced CT scan, but 3 cases of mesenteric vascular thrombi had been missed by CT. The indirect CT sign is intestinal ischemia could be soon in all the 13 cases, that were, bowel dilatation and/or fluid levels in ll cases; thickened bowel wall in 8 cases while thinned bowel wall in 5 cases; pheumatosis intestinalis in 2 cases; mesenteric gas in 1 case and ascites in 4 cases. Conclusion： Abdominal CT especially contrast enhanced MSCT can directly show mesenteric vessel which has importance clinic value in the diagnosis of intestinal ischemia by mesenteic infaretion. Forpatients with acute cryptogenetic abdominalgia, CT scan should be immediately performed.