CAJ | 학술논문

目的探讨CT扫描中肠壁增厚结合密度改变征象对单纯性小肠梗阻(SI)和绞窄性小肠梗阻(ST)的鉴别诊断价值.方法回顾性分析53例经手术病理或临床证实,且术前CT有小肠壁增厚(厚度＞3mm)的小肠梗阻患者资料,其中SI 27例,ST 26例.所有患者均行CT平扫,35例同时行增强扫描.把增厚肠壁的密度改变分为:内层密度正常、内层密度减低、全层密度减低、内层密度增高和全层密度增高.对SI和ST患者增厚肠壁的密度改变进行分析,并采用x2检验或Fisher精确概率法比较2组患者肠壁密度改变的差异.结果 CT平扫表现为内层密度正常者,SI 21例,ST6例,差异有统计学意义(x2=15.859,P＜0.01);但增强扫描表现为内层密度正常的SI 13例,ST5例,差异无统计学意义(x2=1.377,P＞0.05).平扫表现内层密度减低SI 4例,ST 5例;增强扫描内层密度减低SI 4例,ST 4例,差异均无统计学意义(P值均＞0.05).平扫全层密度减低ST 10例,增强全层密度减低ST 5例,均无SI患者,差异均有统计学意义(P值均＜0.01).结论 CT影像上肠壁增厚伴肠壁全层密度减低这一征象可以鉴别SI和ST.
목적 탐토CT소묘중장벽증후결합밀도개변정상대단순성소장경조(SI)화교착성소장경조(ST)적감별진단개치.방법 회고성분석53례경수술병리혹림상증실,차술전CT유소장벽증후(후도＞3mm)적소장경조환자자료,기중SI 27례,ST 26례.소유환자균행CT평소,35례동시행증강소묘.파증후장벽적밀도개변분위:내층밀도정상、내층밀도감저、전층밀도감저、내층밀도증고화전층밀도증고.대SI화ST환자증후장벽적밀도개변진행분석,병채용x2검험혹Fisher정학개솔법비교2조환자장벽밀도개변적차이.결과 CT평소표현위내층밀도정상자,SI 21례,ST6례,차이유통계학의의(x2=15.859,P＜0.01);단증강소묘표현위내층밀도정상적SI 13례,ST5례,차이무통계학의의(x2=1.377,P＞0.05).평소표현내층밀도감저SI 4례,ST 5례;증강소묘내층밀도감저SI 4례,ST 4례,차이균무통계학의의(P치균＞0.05).평소전층밀도감저ST 10례,증강전층밀도감저ST 5례,균무SI환자,차이균유통계학의의(P치균＜0.01).결론 CT영상상장벽증후반장벽전층밀도감저저일정상가이감별SI화ST.
Objective To investigate the CT diagnostic value of small bowel wall thickness and density in differentiating simple small bowel obstruction (SI) from strangulative small bowel obstruction (ST).Methods Fifty-three cases with thickened small bowel wall (thickness ＞ 3 mm) confirmed on CT scan were reviewed,including 27 cases of SI and 26 cases of ST,in conjunction with their proven intraoperational,pathological and clinical findings.Of the 53 cases,35 cases also underwent postcontrast CT scan.CT manifestations of relationships between thickened small bowel wall and its density were classified as normal,higher or lower density in tunica mucosa of small bowel wall,higher or lower density in full thickness of small bowel wall for exploring the differential diagnostic features between SI and ST on CT scan.Chi-square or Fisher exact test were used to test the proportion difference of CT scan between SI and ST.Results In cases with normal density in tunica mucosa (NDTM) on precontrast CT,there were 21 cases of SI and 6 cases of ST(x2 =15.859,P ＜0.01).However,in cases with NDTM on postcontrast CT,there were 13 cases of SI and 5 cases of ST,and there was no significant difference (x2 =1.377,P ＞ 0.05).Thus,NDTM showed no convincing value in differentiating SI from ST.In cases with lower density in tunica mucosa (LDTM) on precontrast CT,there were 4 cases of SI and 5 cases of ST (P ＞ 0.05).In cases with LDTM on postcontrast CT,there were 4 cases of SI and 4 cases of ST (P ＞ 0.05).Thus,LDTM also showed no value in differentiating SI from ST.The lower density in full thickness of small bowel wall (LDFTS) was revealed in 0 of SI and 10 cases of ST on precontrast CT (P ＜ 0.01),and 0 of SI and 5 cases of ST on postcontrast CT (P ＜ 0.01),indicating that LDFTS showed significant value in differentiating SI from ST.Conclusion Combining the small bowel wall thickness and density,CT manifestations of early bowel wall pathological changes in small bowel obstruction can be acquired,adding some value in the differential diagnosis between SI and ST.