摘要
目的探讨术前增强MSCT对胆囊穿孔的诊断价值。方法回顾性分析25例经手术或穿刺确诊为胆囊穿孔患者的术前增强MSCT图像,总结其各种影像学表现。结果术前腹部增强MSCT横断位直接清晰显示胆囊壁局部薄弱、连续性中断11例(44%),2例经冠状位重建后清晰显示破裂口,另1例胆囊内及壁外多发气肿,2例胆囊内及壁外、膈下见气液平面,提示胆囊穿孔;2例胆囊壁不规则,局部模糊不清,肝周包裹性积液或腹腔大量积液,怀疑胆囊穿孔。胆囊体积增大13例,胆囊萎缩5例;合并有胆囊结石11例,无胆囊结石14例;弥漫性腹膜炎16例,胆囊窝积液18例,肝包膜下包裹性积液4例,肝实质受累7例,形成肝脓肿2例,胆囊十二指肠瘘3例,小肠梗阻4例。故术前增强MSCT明确诊断胆囊穿孔16例(64%),可疑诊断2例,未能在术前作出诊断7例。结论胆囊穿孔的影像学表现多种多样,增强MSCT可显示其各种直接及间接征象,对胆囊穿孔有明确诊断及重要的提示作用。
Objective This study is to investigate the values of using enhanced multi-slice helical computed tomography （MSCT） in diagnosing gallbladder perforation. Methods Twenty-five cases of gallbladder perforation were diagnosed by surgery or biopsy. Imaging features of the preoperative enhanced MSCT were analyzed and then summarized retrospectively. Results Ax- ial slices of the preoperative abdominal enhanced MSCT directly and clearly showed the local weakness and discontinuity of gall- bladder wall in 11 cases （44%）. Two cases showed the rupture hole clearly after coronal reconstruction. Multiple emphysema within gallbladder wall was observed in one case and air fluid level inside gallbladder or outside of it （ e. g, subphrenic） was found in 2 cases, with greatly indicated gallbladder perforation. Moreover, there were another 2 cases showing irregular and locally blurred gallbladder wall with peripheral hepatic pleural effusion or massive ascites, which was suspected as gallbladder perfora- tion. Among these cases, 13 of them had increased gallbladder volume while 5 had atrophic alteration. Cholecystolithiasis was ob- served in 11/25 of the cases while 16/25 suffered from diffuse peritonitis, 18/25 showed gallbladder fossa effusion and 4 of them had hepatic subcapsular encapsulated effusion. Liver parenchyma was involved in 7 cases, liver abscess formation in 2 cases, gallbladder duodenal fistula in 3 cases and small intestinal obstruction in 4 cases. In total, the corrected diagnosis of gallbladder perforation with the help of preoperative enhanced MSCT could be made in 16 cases （64%）, and suspected in 2 cases, however, it was failed to make diagnosis in 7 cases. Conclusion We could observe various direct and indirect imaging features though en- hangced MSCT in the patients with gallbladder perforation, which would contribute to diagnosing gallbladder perforation and provide important indications.
出处
《医学影像学杂志》
2018年第1期90-93,101,共5页
Journal of Medical Imaging
关键词
胆囊穿孔
体层摄影术
X线计算机
诊断
Gallbladder perforation
Tomography, X-ray computed
Diagnosis
