绞窄性肠梗阻的螺旋CT增强扫描征象分析

目的:分析螺旋CT增强扫描图像上绞窄性肠梗阻的征象,提高对绞窄性肠梗阻术前诊断的准确性.方法:64例手术证实的绞窄性肠梗阻病例纳入研究,男43例,女21例,年龄23～72岁,平均42岁.采用单排螺旋CT进行全腹部扫描,对比剂以2～3ml/s速度注射,注射后60s扫描,层厚10mm.参照术中所见,回顾性分析上述CT资料,包括:①间接征象:肠腔扩张积液,肠壁增厚及肠壁密度改变(靶征),肠系膜脂肪水肿及渗出(缆绳征),肠系膜血管增粗并肠系膜扭曲(漩涡征),肠壁间、肠系膜间及门静脉积气,腹水；②直接征象:肠系膜上动脉或上静脉充盈缺损.结果:正确诊断54例,正确率82.8％.CT显示肠腔扩张积液47例(73％),其中6例积液呈高密度提示肠腔内积血(9.3％)；肠壁水肿增厚19例(29.6％),其中11例增强后肠壁密度不匀,呈“靶征”(17％),8例肌壁未见强化(12.5％)；肠系膜脂肪水肿及渗出(缆绳征)43例(67％),肠系膜血管增粗并肠系膜扭曲呈“漩涡”状9例(14％),肠壁间积气、肠系膜积气各1例,门静脉积气2例,腹水31例(48.4％).肠系膜上动脉或上静脉充盈缺损3例.结论:绞窄性肠梗阻CT表现有一定特征,可做出提示性诊断.

Findings of Strangulated Intestinal Obstruction by Enhanced Spiral CT

Purpose:Through the analysis of the CT signs of strangulated intestinal obstruction to increase the diagnosis accuracy.Methods:The emergency CT plain scan and enhanced CT scan image data of 64 cases which were diagnosed as strangulated intestinal obstruction by operation were analyzed.The CT diagnosis of strangulated intestinal obstruction was based on the presence of two or more of the following signs:l)Bowel expansion and effusion;2)Bowel - wall thickening,high attenuation of the bowelwall on enhanced CT scans,asymmetric bowel - wall enhancement on contrast - enhanced CT scans;3) Mesenteric edema or fluid,(strand sign);4)The mesenteric vascular enlarged with abnormal route(whirl sign);5) Pneumatosis or portal venous gas;6) Ascites.Once the thrombosis was found in mesenteric veins or mesenteric arteries,the diagnosis could be made.Results:Strangulated intestinal obstruction was prospectively diagnosed by the CT findings in 54 of the 64 patients(82.8%).Bowel expansion and effusion were shown in 47 cases(73%),high density in the extended bowel in 6 cases,bowel - wall thickening in 19 cases(29.6%),asymmetric bowel - wall enhancement on contrast - enhanced CT scans in 11 cases(17%),low attenuation of the bowel - wall on enhanced CT scans in 8 cases(12.5%), mesenteric edema or fluid(strand sign) in 43 cases(67%),whirl sign in 9 cases(14%),pneumatosis in 1 case,portal venous gas in 1 cases,ascites in 31 cases(48.4%).Thrombosis in mesenteric veins or mesenteric arteries was found in 3 cases.Conclusion:CT findings can provide evidences for the diagnosis of strangulated intestinal obstruction.