粘连性小肠梗阻CT表现与肠缺血的相关性分析

摘要

目的 探讨粘连性小肠梗阻CT显示征象与肠缺血的相关性.方法 根据手术和保守治疗结果将患者分为肠缺血坏死组、肠缺血组、无肠缺血组和保守治疗成功组.记录其CT征象,分析梗阻移行带与梗阻近端肠管CT征象的关系以及不同CT征象与肠缺血程度的相关性.结果 梗阻移行带CT征象包括"鸟嘴"征、"成角"征和单纯粘连改变;梗阻近侧肠管CT征象包括内疝样征、闭袢征、扭转征和不同程度的肠缺血改变."鸟嘴"征、"成角"征的近侧肠管出现上述CT征象明显多于单纯粘连改变者,且缺血、坏死发生率明显增高.肠缺血坏死组、肠缺血组、无肠缺血组和保守治疗成功组CT征象种类数依次由多减少,即平均征象数/例分别为3.22、2.66、1.16和0.69,各组间具有显著性的差异,征象数/例与肠管的缺血程度具有高度的相关性(相关系数为0.977).结论 梗阻移行带CT表现类型可提示梗阻的严重程度,结合梗阻近侧肠管的CT征象能有效地判断肠管的缺血状态.%Objective To analyze the correlation between CT manifestations and intestinal ischemia in adhesive small-bowel obstruction.Methods The CT findings of 43 patients with adhesive small-bowel obstruction and met the inclusion criteria were observed.According to evidence of operation and conservative treatment, the cases were divided into intestinal infarct group, ischemia group, un-ischemia group and conservative treatment group.The relation of type of transition zone with CT signs, the correlation of CT signs with ischemia degree were analyzed.Results The types of transition zone were "beak" sign, "angled" sign and intestinal adhesion.Proximate bowel in transition zone showed internal hernia sign, volvulus sign, closed loop sign and intestinal ischemia changes.The bowel obstructions with "beak" sign and "angled" sign had more above CT signs in proximate bowel than pure bowel adhesion and had higher ratio of intestinal ischemia.In sequence of intestinal infarct group, ischemia group, un-ischemia group and conservative treatment group, the number of CT signs were from much to less and the average signs numbers of per case were 3.22, 2.66, 1.16 and 0.69 in order, there were significant statistical differences between each group.The signs numbers had high correlation with degree of intestinal ischemia (correlation coefficient was 0.977).The "beak" sign and "angled" sign accompanied with much CT signs in proximate bowel pointed out intestinal ischemia or infarct.The patients with pure adhesion in transition zone accompanied with no or less CT signs in proximate bowel, which usually manifested no ischemia.Conclusion The type of CT manifestation in transition zone indicated intensity of bowel obstruction and the combing with CT signs in proximate bowel could effectively appraise the condition of bowel ischemia.