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1、中华放射学杂志2006年1月第40卷第1期ChinJRadiol,January2006,Vol40,No.1·81··消化系统放射学·绞窄性肠梗阻肠系膜及其血管改变的CT研究李文华曹庆选杨世锋陆升林张强吴天李建海【摘要】目的对经CT检查、有肠系膜及其血管(MRV)改变的30例绞窄性肠梗阻(SO)进行分析,探讨CT诊断的临床价值。方法30例SO,均行CT平扫,其中20例行增强扫描,均显示有不同形式的MRV改变。26例经手术、4例经临床证实,包括粘连性肠梗阻9例,肠扭转8例,肠套叠6例,肠系膜血管闭塞性肠梗阻4例,内疝
2、3例。结果所有病例经CT检查可发现11种CT征象,并可分作:(1)直接征象:包括肠系膜血管闭塞2例,肠系膜水肿及其血管增粗并形态异常19例;(2)间接征象:包括肠壁水肿增厚24例,CT强化肠壁异常6例,肠腔大量积液13例,肠袢特殊形态10例,肠壁、肠系膜出血各1例;(3)并发症征象:包括肠壁间积气3例,肠系膜门脉积气1例,肠系膜积气1例,腹水和气腹共11例。结论急腹症CT检查如能显示MRV改变,结合其他CT征象和临床,可以对SO术前作出诊断。同时也能观察到传统X线不能显示的并发症。【关键词】肠系膜;肠系膜血管闭塞;肠
3、梗阻;体层摄影术,X线计算机CTstudiesofmesenteryandrelatedvascularfindingsinstrangulatingintestinalobstruction*LIWen-hua,CAOQing-xuan,YANGShi-feng,LUSheng-lin,ZHANGQiang,WUTian,LIJian-hai.*MedicalImagingCenter,QingdaoHaiciMedicalGroup,Qingdao266033,China【Abstract】ObjectiveTo
4、investigatetheCTappearanceofmesenteryandrelatedvascular(MRV)findingsinstrangulatingobstruction(SO)andevaluatethevalueofCTexaminationfordiagnosingSO.MethodsThirtypatientswithSOwereincludedintheinvestigation.Thediagnosiswasconfirmedbyoperationin26casesand4casesby
5、clinic.ThecauseofSOincludedadhesionin9cases,volvulusin8cases,intussusceptionin6cases,infarctionofmesentericvesselesin4cases,andinternalherniain3cases,respectively.AllpatientswasexaminedwithCTand20ofthemwithenhancedCT.ResultsElevenitemsofCTfindingswererevealedin
6、thesepatients.Thefindingscouldbedividedinto3types:(1)directsigns:includingembolismofmesentericvasculaturein2casesandmesentericedemaandrelatedvascularenlargementin19cases.(2)indirectsigns:includingbowelwalledemaandthickenningin24cases,abnormalenhancementofthewal
7、lin6cases,massivefluidinthebowelin13cases,abnormalformofloopsin10cases,andhemorrhageofbowelwallandmesenteryin1caseeach.(3)complicatedsigns:includingintramuralgasin3cases,intrahepaticportalveinsgasin1case,gasinmesenteryin1case,andascitesandpneumoperitoneumin11ca
8、ses.ConclusionTheCTfindingsofmesentericedema,ischemiaandinfarctionarereliableandcharacteristicsignsfordiagnosingSO.ThediagnosisofSOcanbecorrectlymadebeforeoperationifthesesi
