CT分析肠梗阻腹腔积液

目的 探讨CT发现腹腔积液对于诊断不同阶段肠梗阻的价值。方法 回顾性分析经手术病理证实的414例肠梗阻患者的CT资料，按肠壁缺血程度对129例符合研究标准的病例进行分组：A组（MIO，无肠缺血），B组（SIO早期，有肠缺血），C组（SIO晚期，有肠坏死或穿孔），统计各组腹腔积液检出率、位置、量及CT值差异。结果 A、B、C组 CT腹腔积液检出率分别为51.16%（22/43）、87.10%（27/31）和85.45%（47/55），总体差异、A组与B组和C组差异均有统计学意义；肝周及肠间隙腹腔积液检出率3组间差异有统计学意义，肝周腹腔积液检出率3组间两两比较差异均有统计学意义，肠间隙腹腔积液检出率A组与B组及C组差异有统计学意义；多处腹腔积液检出率及脾周、结肠旁沟、盆腔腹腔积液检出率3组间差异均无统计学意义。腹腔积液量3组间差异有统计学意义，A组和B组与C组差异有统计学意义。腹腔积液CT值差异无统计学意义。结论 腹腔积液是肠梗阻常见征象。CT是否检出腹腔积液及积液量不是评估肠梗阻肠壁血运状况的独立指标。

CT analysis of ascites in intestinal obstruction

Objective To investigate the occurrence of ascites in different pathological stages of intestinal obstruction using CT. Methods Totally 414 cases of intestinal obstruction proved by surgery and pathology were retrospectively analyzed. Patients enrolled in the study according to the inclusion criteria (n=129) were assigned to three groups by the degree of intestinal ischemia: Group A included patients with mechanical intestinal obstruction (MIO) without intestinal ischemia, group B included patients with early strangulated intestinal obstruction (SIO) with intestinal ischemia, while group C included patients with late SIO with intestinal necrosis or perforation. The differences of CT detection rate, location, volume and CT value of ascites were analyzed among three groups. Results CT detection rate of ascites in group A, B and C were 51.16% (22/43), 87.10% (27/31) and 85.45% (47/55), respectively (P<0.05). The difference between group B and C was not statistically significant, while statistical difference was found between group A and B, as well as between group A and C. CT detection rates of ascites located around liver or intestinal gap were statistically different among three groups and between every two groups. CT detection rates of ascites located around intestinal gap were significantly different between group A and B, as well as between group A and C, but not between group B and C. CT detection rates of multi-located ascites, of ascites just around spleen, paracolic gutter or pelvis were not statistically different. For volume of ascites, difference between group A and B was not statistically significant, but there were statistical differences between group C and A, as well as C and B. No significant difference of CT value of ascites was found among three groups. Conclusion Ascites is common in intestinal obstruction. Neither the existing or not of ascites nor its volume can be used as independent predictors for perfusion status of intestinal obstruction.