肠梗阻的CT诊断.docVIP

肠梗阻的CT诊断 范红燕 侯艳军 慕建成 赵庆 [摘要] 目的:探讨CT对肠梗阻的诊断价值。方法:回顾性分析51例经手术或临床证实肠梗阻患者的CT资料。结果:CT能100%显示肠梗阻。CT对梗阻病因诊断准确90.2%，能鉴别麻痹性肠梗阻和机械性肠梗阻。对梗阻部位诊断准确96.1%，绞窄性肠梗阻诊断准确率100%。结论:CT检查可判断肠梗阻，确定肠梗阻的原因、部位以及性质，是肠梗阻检查的最佳方法。 [关键词] 肠梗阻;体层摄影术;X线计算机;诊断 CT Diagnosis of Intestinal obstruction FAN Hongyan,Hou Yanjun,Mu Jiancheng,et al.Department of CT,the Second People Hospital of Jiaozuo, Jiaozuo 454000,China [Abstract] Objective To analyze the diagnostic value of CT for intestinal obstruction. Methods The CT data of 51 cases of intestinal obstruction were retrospectively analyzed that all were confirmed intestinal obstruction by operation or clinical diagnosis. Results to 51 cases of intestinal obstruction, CT diagnostic accurate rate was 100%,and the accurate rate of the cause was 90.2% . CT can help differentiate between mechanical obstruction and paralytic ileus. CT diagnostic accurate rate of obstructive location was 96.1% , and the accurate rate of strangulated intestinal obstruction was 100%.Conclusion The CT examination can judge intestinal obstruction, and determine cause, location and property of intestinal obstruction. It is the best way to diagnosis of intestinal obstruction. [Key words]Intestinal obstruction; Tomography;X-ray computed; diagnosis 肠梗阻是外科常见的急腹症，肠梗阻的部位、程度及原因，有无闭袢性肠梗阻及肠缺血、肠绞窄对肠梗阻的治疗有重要意义。笔者回顾性分析51例经手术或临床证实的肠梗阻患者的CT资料，旨在探讨CT对肠梗阻的诊断价值。 1 资料和方法 1.1 一般资料 51例经手术或临床证实（48例手术证实，3例麻痹性肠梗阻临床随访证实）肠梗阻患者中，男33例，女18例，年龄23~76岁，平均年龄41岁。临床症状：不同程度的腹痛、腹胀、呕吐及肛门停止排气、排便。 1.2 检查方法 采用Picker UltraZ螺旋CT机，36例病情较重直接扫描，15例病人症状较轻，检查前5min口服1%泛影葡胺800ml。扫描范围从膈顶至耻骨联合水平一次完成。部分病例病变部位加作5mm扫描。扫描条件120Kv，250mA，距阵512×512，层厚10mm，螺距1.5。11例并行CT增强扫描。增强对比剂为80~100ml碘海醇，注射速度3ml/s。注药后25~35s动脉期扫描，70~85s门脉期扫描。 1.3 CT观片内容 ①肠梗阻判断标准[1]：小肠管径扩张内径大于2.5cm，结肠管径扩张大于6.0cm。近端肠管与正常或塌陷管径之间为“移行带”。②梗阻部位的判定：从远侧肠管开始，逆行向近侧肠管追踪直至遇见扩张肠管为梗阻部位，通过比较扩张与塌陷肠管的分布及多少来判断梗阻平面的高低。③肠梗阻病因诊断标准：麻痹性肠梗阻CT表现为成比例的小肠和结肠扩张，而没有扩张肠袢与塌陷肠袢之间的“移行带”。存在“移行带”为机械性肠梗阻。“移行带”发现明确病变并能判断为肿瘤、肠套叠、肠扭转、疝、炎症或粪石等, “移行带”未发现明确病变则考虑为粘连性肠梗阻。④闭袢或绞窄性肠梗阻的判断：扩张肠袢及肠系膜血管以梗阻部位为中心呈放射状分