摘要
目的探讨CT及X线小肠造影对小肠克罗恩病（CD）的诊断价值。方法回顾性分析经手术和病理证实的39例CD患者的临床病理资料。患者均有完整的CT小肠造影检查资料，其中28例患者同时行X线小肠钡餐造影检查，腹部窦道造影18例。结果39例CT小肠造影，主要表现为肠壁增厚（大于4ram）34例（87．2％），强化增加（大于10HU）37例（94．9％），多节段性病变33例（84．6％），肠腔不规则狭窄26例（66．7％），系膜区淋巴结肿大（大于5mm）13例（33．3％），肠管周围蜂窝织炎12例（30．8％），腹腔内脓肿10例（25．6％），炎性包块8例（20．5％），不全性肠梗阻14例（35．9％），腹腔积液22例（56．4％），瘘管形成4例（10．3％）；CT小肠造影未显示肠壁线形溃疡和卵石征，对肠瘘的显示率不高。28例X线小肠造影，多节段性病变23例（82．1％），单节段病变5例（17．9％），肠腔不规则狭窄15例（53．6％），多发性、纵行裂隙状溃疡18例（64．3％），卵石征16例（57．1％），肠瘘4例（14_3％）；X线小肠造影未显示肠壁增厚及腹腔脓肿、炎性包块等肠外并发症，对肠瘘的显示率亦不高。18例腹部窦道造影中，肠瘘13例（72．2％），腹腔脓肿形成12例（66．7％），窦道形成8例（44．4％）。结论CT小肠造影对全面评价CD的病变范围、并发症及指导临床治疗具有重要作用，但难以显示肠壁线形溃疡和卵石征。X线小肠造影易于显示CD的线形溃疡和卵石征的特征性改变，而腹部窦道造影易于显示肠瘘及腹腔内脓肿。两种检查方法相互结合，对于指导CD的临床诊断及综合治疗具有重要价值。
Objective To investigate the value of CT and X-ray enterography in the diagnosis of small intestinal Crohn disease（CD）. Methods Data of 39 CD cases confirmed by surgery and pathology who underwent CT and X-ray enterography were analyzed retrospectively. All the patients had complete CT data, 28 cases had X-ray intestinal barium meal data, and 18 had sinus tract enterography. Results CT enterography showed mural thickening（〉 4 mm） in 34（87.2%） patients, mural gas in 7（17.9%）, mural edema in 7（17.9%）, mural fat in 4（10.3%）, increased enhancement of bowel wall （〉10 HU）in 37（94.9%）, multiple segmental lesions in 33（84.6%）, single segmental lesions in 6（15.4%）, mesenteric lymphadenopathy（〉 5 mm） in 13（33.3%）, vascular bundle thickening in 9（23.1%）, cellulitis in 12（30.8%）, peritoneal abscess in 10（25.6%）, phlegmon in 8（20.5%）, incomplete intestinal obstruction in 14（35.9%）, seroperitoneum in 22（56.4%）, and fistulization in 4（103%）. CT enterography did not demonstrate the change of mucosa such as strip ulcer or cobblestone. Among the 28 cases of small bowel X-ray enterography, 23 cases （82.1%） presented with multiple segmental lesions, 5 （ 17.9% ） with single segmental lesions, 18 （64.3 % ） with strip ulcer, 16 （57.1% ） with cobblestones, 4（14.3%） with intestinal fistula, while no bowel wall and extraintestinal complication of CD disease was observed. Among the 18 cases of sinus tract enterography, 13 cases （72.2%） presented with intestinal fistula, 12（66.7%） with peritoneal abscess, 8（44.4%） with sinus tract. Conclusions CT enterography can demonstrate exactly the diseased bowel wall and extraintestinal complication of CD disease, which is important to evaluate the extent of CD and guide the treatment, however strip ulcer and cobblestone sign cannot be demonstrated. The X-ray enterography is available to demonstrate the characteristic changes of CD such as trip ulcers and cobblestones, but is difficult to
出处
《中华胃肠外科杂志》
CAS
CSCD
2013年第5期443-447,共5页
Chinese Journal of Gastrointestinal Surgery
基金
苏北人民医院重点院级基金（yzucms201203）
