CT鉴别粘连性小肠梗阻所致肠缺血和梗死的价值

摘要

目的:探讨CT鉴别粘连性小肠梗阻所致肠缺血和梗死的价值.方法:37例粘连性小肠梗阻患者按照手术结果分为小肠缺血组(25例)和梗死组(12例),回顾性比较两组间CT表现有无差异,分析有意义的CT表现鉴别肠缺血和梗死的价值.结果:肠壁积气、肠系膜浑浊、肠壁强化减低、肠系膜动脉和静脉强化减低出现的几率在梗死组显著高于缺血组(P<0.05),预测小肠梗死的比数比分别为3.78、11.91、10.15、16.50、19.55.同时具备4个以上征象,预测梗死的阳性预测值达83.3%(10/12).结论:CT有助于鉴别粘连性小肠梗阻所致的肠缺血和梗死,肠系膜静脉强化减低为最有价值的CT表现.%Objective: To investigate the value of CT in differentiating small bowel ischemia from infarction in patients with adhesive small bowel obstruction (ASBO). Methods: According to operative results, thirty-seven patients with ASBO were classified into ischemia group and infarction group. The CT findings of two groups were retrospectively compared and analyzed. Results: The incidence of bowel wall pneumatosis, mesenteric haziness, decreased enhancement of bowel wall, decreased en-hancement of mesenteric arteries and veins of on CT imaging in the infarction group was statistically higher than that in the ischemia group, with odds ratio for infarction of 3.78, 11.91, 10.15, 16.50, and 19.55, respectively. The positive predictive value of a combination of 4 or more CT findings for small bowel infarction was 83.3%(10/12). Conclusion: CT imaging find-ing is helpful in differentiating small bowel ischemia from infarction in patients with ASBO, and decreased enhancement of mesenteric veins is the most valuable CT findings.