CT在急性小肠梗阻病因诊断和处理中的价值

目的　探讨CT在急性小肠梗阻病因诊断和处理中的价值。方法　回顾性分析经手术病理和临床随访结果证实的 5 5例小肠梗阻的CT征象和记录由于CT的信息而在治疗上发生的改变。进行腹部CT横断平扫和静脉增强扫描 ,2 4例进行冠状位重建。结果　 5 5例小肠梗阻的病因中 ,粘连性小肠梗阻 2 4例 ( 4 3 .6% ) ,小肠肿瘤 (含复发 ) 10例 ( 18.2 % ) ,腹外疝 5例 ( 9.1% ) ,炎性作用引起小肠梗阻 6例 ( 10 .9% ) ,肠套叠 4例 ,小肠扭转 2例 ,肠石性 2例 ,外伤后麻痹性肠梗阻 1例 ,先天性 1例小肠重复畸形。在CT检查前 ,病因诊断正确 2 3例 ( 4 2 % ) ,而CT提示正确病因诊断者 5 0例 ( 91% ) ,经CT确诊后 ,使临床治疗方案发生改变者 16例 ( 2 9% )。结论　CT扫描能够明显提高小肠梗阻的病因诊断正确率 ,并且提高了临床正确处理的能力

The Value of CT in the Diagnosis and Management of Patients with Acute Small-Bowel Obstruction

Objective To evaluate the role of CT in the diagnosis and management of patients with acute small-bowel obstruction.Methods CT findings in 55 cases with acute small-bowel obstruction, proved by surgery or clinical follow-up were retrospectively analyzed. The changes in therapy according to CT informations were recorded. Pre-and post-contrast CT scan of the abdomen was performed in 55 cases ,and the coronary images were reconstructed in 24 cases.Results The etiology resulted in acute small-bowel obstruction in 55 cases included adhesion(24 cases) ,primary or secondary neoplasm(10 cases),external hernia(5 cases) ,inflammatory process(6 cases) ,intussusception (4 cases),bowel torsion (2 cases),enterolith (2 cases),congenital lesion (1 case),paralytic ileus after trauma (1 case).The diagnosis of the causes of obstruction in 23 cases(42%) by clinic and in 50 cases(91%) by CT scan was correct.After sure diaguosis by CT scan,the clinical management was changed in 16 cases(29%).Conclusion CT scan not only is useful in establishing the cause of the acute small-bowel obstruction ,but also it help surgeons to improve the ability to correctly manage obstruction.