CT小肠成像对肠梗阻部位及病因的诊断价值

目的研究CT小肠成像对肠梗阻部位及病因的诊断价值。方法选取我院2012年9月至2014年9月46例经手术病理证实肠梗阻患者为研究对象,采取美国GE Lightspeed64层螺旋CT仪进行平扫及三期增强扫描,分析MSCT对肠梗阻的检出率、病因和梗阻部位的判断价值。结果 46例肠梗阻患者均检出,检出率100%,27例移行带显示清晰,46例患者均可见肠管明显扩张(2.5cm)、积气及积液;病理证实高、低位梗阻均为23例,CT检查结果高位梗阻27例,低位梗阻19例,梗阻定位准确性91.30%(42/46);手术病理诊断粘连性肠梗阻16例,肠套叠肠梗阻6例,血运性肠梗阻4例,外伤性肠梗阻2例,内疝1例,肠扭转2例,肿瘤性肠梗阻12例,肿瘤压迫型梗阻3例,CT诊断粘连性肠梗阻12例,肠套叠肠梗阻7例,血运性肠梗阻4例,外伤性肠梗阻2例,肠扭转3例,肿瘤性肠梗阻16例,肿瘤压迫型梗阻3例。误诊5例,4例粘连性肠梗阻误诊为肿瘤性肠梗阻,1例内疝误诊为肠扭转,病因诊断准确率89.13%(5/46)。结论 CT小肠成像对肠梗阻的诊断准确度高,且用于肠梗阻病因、部位的鉴别有较高的准确性,可为后期治疗、随访等提供可靠依据。

The Diagnostic Value of CT Small Bowel Imaging in the Location and Etiology of Intestinal Obstruction

Objective To study the diagnostic value of CT small bowel imaging in the location and etiology of intestinal obstruction. Methods 46 patients with intestinal obstruction which confirmed by surgery and pathology in our hospital from September 2012 to September 2014 were selected as the research objects. The GE Lightspeed 64-slice spiral CT instrument made by America was adopted to carry out plain scan and three phase enhanced scan. The detection rate of MSCT in diagnosis of intestinal obstruction and the value in judging the cause and the location of the obstruction were analyzed. Results 46 cases of patients with intestinal obstruction were detected and the detection rate was 100%. 27 cases of transition zone were clearly displayed. 46 patients were with visible expansion (longer than 2.5cm), pneumatosis and hydrops; Pathology proved that the number of high and low obstruction were 23 cases. The results of CT examination showed high obstruction in 27 cases, low obstruction in 19 cases, 4 cases of low obstruction misdiagnosed as high obstruction and the accuracy of localizing obstruction was 91.30%(42/46);16 cases were diagnosed as adhesive intestinal obstruction by surgery and pathology, 6 cases as intussusception intestinal obstruction, 4 cases as mesenteric vascular obstruction, 2 cases as traumatic intestinal obstruction, 1 case as internal hernia, 2 cases as volvulus, 12 cases as intestinal obstruction caused by neoplasm and 3 cases as tumor compression type obstruction. There were 12 cases of adhesive intestinal obstruction, 7 cases of intussusception intestinal obstruction, 4 cases of mesenteric vascular obstruction, 2 cases of traumatic intestinal obstruction, 3 cases of volvulus, 16 cases of intestinal obstruction caused by neoplasm and 3 cases of tumor compression type obstruction diagnosed by CT. 5 cases were misdiagnosed. 4 cases of adhesive intestinal obstruction were misdiagnosed as neoplastic intestinal obstruction and 1 case of internal hernia misdiagnosed as intestinal volvulus. The accuracy of etiological diagnosis was 89.13%(5/46). Conclusion The accuracy of CT small intestinal imaging in the diagnosis of intestinal obstruction is high and it is of high accuracy in differentiation of the etiology and location of intestinal obstruction, which can provide reliable basis for later treatment and follow-up.