粘连性肠梗阻的多层螺旋CT诊断及其临床应用价值

目的:探讨多层螺旋CT对粘连性肠梗阻的诊断作用。方法:对35例手术证实为粘连性肠梗阻患者的术前全腹多层螺旋CT征象进行回顾性分析，并以手术、病理结果为标准，评价CT诊断的准确性。结果:35例患者CT均确定了梗阻的存在。31例单发梗阻CT均准确确定了梗阻部位，4例多发梗阻者CT确定了11处梗阻中的9处。26例非癌性粘连中23例在CT上均有相应的CT征象支持粘连性肠梗阻的诊断;9例癌性粘连中5例CT发现癌性粘连的直接征象，2例提示癌灶复发或淋巴结转移。根据CT征象判断绞窄性肠梗阻的敏感性93.3％，特异性87.5％，准确性为91.4％。结论:多层螺旋CT可较为全面地评价粘连性肠梗阻，对于指导临床诊疗有较大帮助。

Clinical application value of multislice spiral CT in diagnosing adhesive intestinal obstruction

Abstract:Objective:To investigate the role of multislice spiral CT in diagnosing adhesive intestinal obstruction.Methods :Whole abdominal multislice spiral CT scanning was performed in 35 cases of adhesive intestinal obstruction that were confirmed by operation. The CT signs were retrospectively analyzed and were evaluated in accordance with operative and pathologic results.Results:All patients were identified to have intestinal obstruction on CT. For 31 patients with single site of obstruction, the site of obstruction was accurately identified on CT in all the pationts; for 4 patients with multiple site of obstruction, 9 of 11 obstruction sites were accurately identified on CT. Among 26 cases of non-carcinoma adhesive intestinal obstruction, 23 cases had corresponding CT signs to support the diagnosis; among 9 cases of carcinoma adhesive intestinal obstruction, 5 had direct signs of carcinoma adhesions on CT, and 2 had signs indicating the recurrence of carcinoma. The CT signs indicating intestinal strangulation were as follows: “beak sign”, “target sign”, poor or no contrast enhancement of the bowel wall, “whirl sign”, mesenteric vascular engorgement, mesenteric haziness, ascites, and “C” or “U” shaped loops. When the presentation of 2 or more signs listed above was used as the standard to diagnose the strangulated intestinal obstruction, it had a sensitivity of 93.3%, specificity of 87.5% and accuracy of 91.4%.Conclusions:Multislice spiral CT is very useful in the diagnosis of adhesive intestinal obstruction, and is a helpful guide for the clinical management of adhesive intestinal obstruction.