CT征象预测粘连性小肠梗阻手术时机

目的 探讨可用以预测粘连性小肠梗阻(ASBO)患者手术时机的特异性CT征象。方法 回顾性分析51例粘连性小肠梗阻患者的临床和CT影像资料,其中手术组18例,保守治疗组33例,由2名主治医师对所有CT图像进行分析及术前评估。评价指标包括梗阻程度(完全性或不完全性)、移行带、粘连带位置、肠系膜脂肪密度增高、小肠粪征、腹腔积液共6种CT征象。统计比较手术组与保守治疗组患者CT征象的差异。结果 经Logistic回归模型分析发现,粘连性小肠梗阻的6种CT征象中,完全性肠梗阻(P=0.031)、肠系膜脂肪密度增高(P=0.031)、小肠粪征(P=0.002)具有统计学意义,其中完全性肠梗阻和肠系膜脂肪密度增高的OR>1,而小肠粪征OR<1。结论 完全性小肠梗阻、肠系膜脂肪密度增高、小肠粪征3个CT征象对于预测ASBO患者手术时机具有良好的参考价值。

CT features for predicting surgery timing of adhesive small-bowel obstruction

Objective To analyze the CT features for predicting surgical treatment in patients with adhesive small-bowel obstruction(ASBO). Methods A retrospective analysis was made on the clinical and CT imaging data of 51 patients with ASBO(18 patients of surgery group, 33 patients of conservation group), and the all of the CT images were diagnose and preoperative evaluate by two attending physicians. The index included degree of ASBO(complete obstruction, incomplete obstruction), presence of transition zone, location of adhesive band, mesenteric fat stranding, small-bowel feces sign and peritoneal fluid. These CT index were statistically compared between the surgery group and the conservation group. Results There were three of the six characteristic signs for predicting the need for surgery in patients with ASBO, of which were statistically significant by Logistic regression analysis. They were complete ASBO(P=0.031, OR>1), mesenteric fat stranding(P=0.031, OR>1), small-bowel feces sign(P=0.002, OR<1). Conclusion Complete ASBO, mesenteric fat stranding and small-bowel feces sign has good reference value for predicting surgery timing of ASBO patients.