急性绞窄性小肠梗阻的CT 诊断

上海第二医科大学学报

Vol.2"No.#$Oct.2$$"

Academic Journal of Shanghai Second Medical University

【作者简介】杨文洁（#%&’(），女，上海人，住院医师，硕士.

【文章编号】)$2"’("’%’（2$$"）#$(#$$"($*

・专题报道・

急性绞窄性小肠梗阻的CT 诊断

杨文洁， 江 浩， 陈克敏

（上海第二医科大学瑞金医院放射科，上海 200025）

【摘 要】目的确定CT 对急性绞窄性小肠梗阻的影像学诊断价值。方法收集经手术证实的急性绞窄性小肠梗阻

（n =17）和单纯性梗阻（n =19）患者术前腹盆部CT 检查资料，对肠梗阻的CT 征象进行逐一分析，以判断梗阻性质。结果CT 对单纯性小肠梗阻组诊断正确率达95%，

而绞窄组诊断正确率为82%。梗阻肠段肠壁增厚对于诊断急性绞窄性小肠梗阻的敏感度及特异度分别为88%、74%；靶征为12%、100%；肠壁强化异常为12%、100%；肠壁积气为29%、100%；肠系膜积液为94%、58%；肠系膜血管水肿47%、100%；漩涡征为12%、100%；鸟嘴征为18%、100%；腹水为59%、84%。结论CT 是一种诊断急性绞窄性肠梗阻有效、快速的方法。梗阻肠段肠壁强化缺如、肠壁积气、缆绳征、靶征、漩涡征和鸟嘴征，为诊断绞窄性肠梗阻的较为特异性的征象；而梗阻肠壁增厚、肠系膜积液、腹水等征象，对于急性绞窄性小肠梗阻的诊断具有一定价值。【关键词】急性小肠梗阻； 绞窄性； 计算机体层成像【中图分类号】+574,2； +814,42 【文献标识码】-

CT Diagnosis in Acute Small Bowel Obstruction with Stangulation

YANG Wen-jie ，JIANG Hao ，CHEN Ke-min

（Department of Radiology ，Ruijin Hospital ，Shanghai Second Medical University ，Shanghai 200025，China ）

Abstract ：)Objective )To determine the value of helical CT and of various signs of stangulation in the context of

acute small bowel obstruction.)Methods )From January 2$$2to the present ，./patients with acute small bowel obstruction （#&with stangulation ，#%without stangulation ）were confirmed surgically and pathologically.A series of CT signs were analysed.)Results )CT diagnosis was correct in #’patiens without strangulation and #*patients with strangulation.Mural thickening had a sensitivity rate of ’’%and a specificity rate of &*%，target sign had a sensiti-vity rate of #2%and a specificity rate of #$$%，reduced enhancement of the small bowel wall had a sensitivity of #2%and a specificity of #$$%，pneumatosis intestinalis had a sensitivity rate of 2%%and a specificity rate of #$$%，mesenteric fluid had a sensitivity rate of %*%and a specificity rate of "’%，mesenteric strangulation had a sensitivity rate of *&%and a specificity rate of #$$%，the whirl sign had a sensitivity rate of #2%and a specificity rate of #$$%，the beak sign had a sensitivity rate of #’%and a specificity rate of #$$%，ascites had a sensitivity rate of "’%and a specificity rate of ’*%.)Conclusion )Computed tomography is a fast ，valuable non-invasive ex-amination in the diagnosis of acute small bowel obstuction with stangulation.

Key words ：)acute small bowel obstruction ；)strangulation ；)computed tomography

))急性小肠梗阻是一种常见的急腹症，梗阻肠段是否出现血供障碍，即绞窄与否，对于临床治疗方法的选择及预后具有重要意义。以往急性绞窄性肠梗阻的诊断依据为病史、体检、生化检查及腹部平片，诊断正确率较低。近年来，随着CT 技术的发展及临

床医师对急性绞窄性小肠梗阻认识的不断加深，国外其CT 诊断正确率已达’.%0#$$%［#0.］。而国内目前相关研究较少，本文收集两组急性单纯性及绞窄性小肠梗阻共./例，对其CT 征象作回顾性分析比较如下。

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5001・