CAJ | 학술논문

目的：探讨64排螺旋CT在妇科急腹症中的诊断价值。材料与方法回顾分析23例手术病理证实的妇科急腹症术前急诊CT资料，23例均行腹部平扫及增强检查，手术证实9例输卵管妊娠破裂；6例卵巢肿瘤蒂扭转；5例盆腔脓肿；2例卵巢囊肿破裂；1例输卵管扭转。结果23例均表现为盆腔内包块，其中合并盆腔积液或积血15例。输卵管妊娠破裂CT表现：附件区不均匀强化的混合密度包块，盆腔积血，伴有轻中度强化的囊性区(6例)或异常强化密度影(2例)；卵巢肿瘤蒂扭转：囊壁不同程度水肿增厚、密度升高，可见增粗的蒂(3例)，囊壁、蒂、肿瘤实质均不同程度强化减弱或不强化；盆腔脓肿为盆腔内与周边广泛粘连的多发或单发囊性包块，囊壁呈“靶征”或呈环形、网格样强化；卵巢囊肿破裂后囊肿变形、张力下降、囊壁不完整，外漏液与囊液密度相当；输卵管扭转：输卵管积液扩张呈腊肠样并见分隔，管壁及分隔强化减弱。结论64排螺旋CT对妇科急腹症的诊断有十分重要价值，通常能于术前明确妇科急腹症的病因。
목적：탐토64배라선CT재부과급복증중적진단개치。재료여방법회고분석23례수술병리증실적부과급복증술전급진CT자료，23례균행복부평소급증강검사，수술증실9례수란관임신파렬；6례란소종류체뉴전；5례분강농종；2례란소낭종파렬；1례수란관뉴전。결과23례균표현위분강내포괴，기중합병분강적액혹적혈15례。수란관임신파렬CT표현：부건구불균균강화적혼합밀도포괴，분강적혈，반유경중도강화적낭성구(6례)혹이상강화밀도영(2례)；란소종류체뉴전：낭벽불동정도수종증후、밀도승고，가견증조적체(3례)，낭벽、체、종류실질균불동정도강화감약혹불강화；분강농종위분강내여주변엄범점련적다발혹단발낭성포괴，낭벽정“파정”혹정배형、망격양강화；란소낭종파렬후낭종변형、장력하강、낭벽불완정，외루액여낭액밀도상당；수란관뉴전：수란관적액확장정석장양병견분격，관벽급분격강화감약。결론64배라선CT대부과급복증적진단유십분중요개치，통상능우술전명학부과급복증적병인。
Objective To investigate the value of 64-slice spiral CT in the diagnosis of gynecological acute abdomen.Materials and Methods The data of CT plain scan and enhanced scan of 23 cases of gynecological acute abdomen which conformed by operation and pathology were analysis retrospectively. There are 9 cases of rupture of tubal pregnancy, 6 cases of pedicle torsion of ovarian tumors, 5 cases of pelvic abscesses, 2 cases of rupture of ovarian cys and 1cases of torsion of uterine tube.Results Pelvic masses were showed on CT in all cases, 15 cases with pelvic cavity effusion or blood. The CT features of rupture of tubal pregnancy included mixed-density masses with uneven enhancement in adnexa, pelvic cavity blood and cystic areas with significantly enhanced(n=6)or abnormal enhancement shadow(n=2)could be seen in the masses. Different degrees of edema and thickening of the cystic wall with thickening pedicelland varying degrees of strengthening weakened or non-enhanced(n=3) were seen in torsional ovarian tumors. The multi or single cystic masses with surrounding pelvic adhesions were showed in pelvic abscesses, the cystic wall was enhanced as the features of "target sign", ring or mesh. Deformation, tension decreased and incomplete cystic wall of the ovarian cyst were seen when the ovarian cyst rupture happened, and the density of outside leakage fluid between cyst fluid was similar. Tubal sausage-like expansion with hydrops and partitioning were showed in torsion of uterine tube, the partitioning and tubal wall were strengthening weakened.Conclusion 64-slice spiral CT has very important value in the diagnosis of gynecological acute abdomen, the cause of gynecological acute abdomen usually can be identified before surgery.