摘要
目的探讨肠及肠系膜损伤各种CT征象对治疗方案选择的指导价值。方法回顾性分析10例手术组及19例保守治疗组肠及肠系膜损伤患者的临床资料和9种CT征象,即肠壁连续性中断、肠壁增厚、肠壁异常强化、肠壁血肿、肠系膜血管内造影剂外溢、肠系膜脂肪渗出、肠系膜血肿、肠外积液及肠外积气,采用调差表方式根据9种CT征象的有无进行诊断。应用配对四格表资料的卡方检验对手术组术前CT诊断结果与术中所见及病理进行对照研究,应用R×C表资料的卡方检验对手术组和保守治疗组各CT征象进行对照分析,当P<0.01时,两组间比较有统计学意义。结果术前CT诊断结果与术中所见及病理结果间无显著统计学差异(c2=5.8182,P=0.0159>0.01),CT诊断BMIs准确率达90%,手术组小肠损伤达75%。手术组与保守治疗组各CT征象比较有明显统计学差异(c2=148.2682,P=0.0000<0.01)。肠壁连续性中断、肠壁异常强化、肠壁血肿、肠系膜血管内造影剂外溢、肠外积气仅见于手术组。结论肠壁连续性中断、肠壁异常强化、肠壁血肿、肠系膜血管内造影剂外溢、肠外积气的出现,提示有手术指征,但必须综合分析诸CT征象,间隔6-8小时CT复查对于特异性不高CT征象诠释有一定价值。
Objective To investigate the guiding value of CT signs in the treatment options of bowel and/or mesenteric injuries.Methods The clinical data and CT signs,including interruption of the bowel wall,bowel wall thickening,abnormal bowel wall enhancement,intramural hematoma,mesenteric contrast medium extravasation,mesenteric"infiltration",mesenteric hematoma,intraperitoneal and/or retroperitoneal fluid,and extraluminal air collection(intraperitoneal,mesenteric or retroperitoneal)were respectively analyzed,of the operation group of 10 cases and the conservation treatment group of 19 cases of BMIs.BMIs diagnosis were performed according to 9 signs of CT by the questionnaire.The control study between CT preoperative diagnosis of BMIs of the operation group and postoperative pathology was analyzed by Chi square test of paired four grid data,CT signs of the operative group and the conservation treatment group were analyzed by Chi square test of R×C table data,there was statistical significance between the two groups(P<0.01).Results There was no significant difference between preoperative CT and postoperative pathological results(c2=5.8182,P=0.0159>0.01).The accuracy rate of CT diagnosis of BMIs was up to 90%,and the small intestinal injury in the operation group was up to 75%.There was significant difference between the operation group and the conservative treatment group(c2=148.2682,P=0.0000<0.01)in the CT signs.Interruption of bowel wall,abnormal bowel wall enhancement,intramural hematoma,mesenteric contrast medium extravasation,extraluminal air collection were only found in the operation group.Conclusion Interruption of bowel wall,abnormal bowel wall enhancement,intramural hematoma,mesenteric contrast medium extravasation,extraluminal air collection are indicative of emergency surgical treatment,but must comprehensively analyze CT signs of BMIs.CT review after 6-8 hours if the patient's condition is stable may help in determining the significance of these nonspecific findings.
作者
赵林芬
许绍奇
赵锡海
ZHAO Lin-fen;XU Shao-qi;ZHAO Xi-hai(Department of Radiology,Nanjing University of Chinese Medicine Affiliated Wujin Hospital of Traditional Chinese Medicine,Changzhou 213161,Jiangsu Province,China)
出处
《中国CT和MRI杂志》
2017年第12期109-112,共4页
Chinese Journal of CT and MRI
