钝性腹部空腔脏器及肠系膜损伤的 CT 诊断

摘要

Objective Try to find imaging indicators for the diagnosis of blunt hollow visceral and mesen-teric injuries and to identify specific reliable CT features for diagnosis by comparing intraoperative findings and pre-operative signs of computed tomography ( CT ) . Methods A total of 100 blunt abdominal trauma patients ( 82 males and 18 females aged from 11 months to 77 years,mean age 37 years) from Jan.2011 to Dec.2013 in our hos-pital were enrolled and analyzed retrospectively.There were 50 patients confirmed by surgery of blunt hollow viscer-al and mesentery injuries ( group A) ,and 50 patients with mere solid abdominal organ injuries ( group B) .One-way ANOVA analysis was employed to test the sensitivity,specificity,positive likelihood ratio and negative likelihood rati-o of CT signs in the preoperative diagnosis.Results Twenty-five (50%) patients in group A had free intra-or ret-roperitoneal air,and 49(98%) patients in group B had either free intra-or retroperitoneal air(P<0.01).Sensitiv-ities of CT signs for preoperative diagnosis were statistically significant in regard to bowel wall thickening ( 40%) , mesentery thickening (42%),mesenteric density increasing (16%),abdominal fat density increasing (18%),and peritoneal thickening (26%).Meanwhile,several signs of CT had a high specificity for diagnosing blunt visceral and its mesentery injuries,such as bowel wall thickening(98%),mesentery thickening (88%),mesenteric density increasing( 98%),increased abdominal fat density (96%),and peritoneal thickening (90%).Conclusion Sev-eral signs of preoperative CT,such as free intra-or retroperitoneal air,bowel wall thickening,mesentery swelling,ele-vated mesenteric density,increased abdominal fat density,and peritoneal thickening are found to be candidate indica-tors for the diagnosis of small bowel injuries with an acceptable sensitivity and specificity.%目的：通过对照分析腹部钝性空腔脏器及肠系膜损伤患者术中发现及术前CT征象，寻找判断空腔脏器及肠系膜损伤的特征性CT表现，以助于提高诊断率。方法回顾性分析2011～2013年我院100例钝性腹部创伤患者，其中男性82例，女性18例；年龄11个月～77岁，平均37岁。将其分为A、B两组，A组为经手术证实的有钝性肠道及肠系膜损伤患者（50例），B组为经手术证实的只有钝性实质性脏器损伤而没有空腔脏器及肠系膜损伤患者（50例），分析两组中与空腔脏器及肠系膜损伤相关的CT征象，采用单因素分析方法，进一步得出有助于判断是否有空腔脏器及肠系膜损伤的CT征象。结果通过分析发现具有统计学意义的征象有：腹腔或腹膜后积气（P＜0.01，敏感度50％，特异度98％），肠管壁增厚（P＜0.01，敏感度40％，特异度98％），系膜增厚（P＜0.01，敏感度42％，特异度88％），系膜密度增高（P＜0.05，敏感度16％，特异度98％），腹腔脂肪间隙密度增高模糊（P＜0.05，敏感度18％，特异度96％），腹膜增厚（P＜0.05，敏感度26％，特异度90％）。结论通过分析发现腹腔或腹膜后积气、肠管壁增厚、系膜增厚、系膜密度增高、腹腔脂肪间隙密度增高模糊等征象有助于判断空腔脏器及肠系膜损伤。