齐齐哈尔医学院学报
齊齊哈爾醫學院學報
제제합이의학원학보
JOURNAL OF QIQIHAR MEDICAL COLLEGE
2015年
6期
798-801
,共4页
周学付%彭晓飞%杨栋梁%刘红艳
週學付%彭曉飛%楊棟樑%劉紅豔
주학부%팽효비%양동량%류홍염
粪石%小肠梗阻%多层螺旋CT
糞石%小腸梗阻%多層螺鏇CT
분석%소장경조%다층라선CT
Bezoar%Small bowel obstruction%Multi-slice spiral computed tomography
目的：分析粪石性小肠梗阻临床和多层螺旋CT（ MSCT）影像的特征，探讨及时有效的诊断措施。方法回顾分析2000—2013年手术证实粪石性小肠梗阻36例的临床和MSCT资料。结果36例中男∶女＝1∶2；农村∶城镇居民＝4∶1；28例（78％）年龄＞60岁。发病时间为10月至次年3月。均无上消化道手术史。临床表现腹痛29例（81％）；呕吐25例（69％）；腹胀19例（53％）；肛门停止排气12例（33％）。发病时间1～60天（平均17天），21例（58％）首诊为肠梗阻。发病至手术时间7～73天（平均22天），术中见腹水29例（81％），粪石位于回肠26例（72％），小肠中段6例（16％），空肠4例（12％）。术前腹部MSCT检查29例（42人次），15例（52％）提示肠梗阻病因（“粪石”7例，“肠套叠”4例，“肿瘤”3例，“肠扭转”1例）。回顾分析上腹检查6人次未见粪石；上、下腹检查29人次2次未见粪石；全腹（上下腹盆腔）检查7人次均见粪石。10例增强扫描肠壁均见强化，而肠腔内粪石及边缘无强化。结论粪石性小肠梗阻病因复杂临床表现无特异性，依据病史和临床表现诊断困难。全腹MSCT检查并具备相应影像诊断经验，可及时准确诊断避免术前误诊误治。
目的：分析糞石性小腸梗阻臨床和多層螺鏇CT（ MSCT）影像的特徵，探討及時有效的診斷措施。方法迴顧分析2000—2013年手術證實糞石性小腸梗阻36例的臨床和MSCT資料。結果36例中男∶女＝1∶2；農村∶城鎮居民＝4∶1；28例（78％）年齡＞60歲。髮病時間為10月至次年3月。均無上消化道手術史。臨床錶現腹痛29例（81％）；嘔吐25例（69％）；腹脹19例（53％）；肛門停止排氣12例（33％）。髮病時間1～60天（平均17天），21例（58％）首診為腸梗阻。髮病至手術時間7～73天（平均22天），術中見腹水29例（81％），糞石位于迴腸26例（72％），小腸中段6例（16％），空腸4例（12％）。術前腹部MSCT檢查29例（42人次），15例（52％）提示腸梗阻病因（“糞石”7例，“腸套疊”4例，“腫瘤”3例，“腸扭轉”1例）。迴顧分析上腹檢查6人次未見糞石；上、下腹檢查29人次2次未見糞石；全腹（上下腹盆腔）檢查7人次均見糞石。10例增彊掃描腸壁均見彊化，而腸腔內糞石及邊緣無彊化。結論糞石性小腸梗阻病因複雜臨床錶現無特異性，依據病史和臨床錶現診斷睏難。全腹MSCT檢查併具備相應影像診斷經驗，可及時準確診斷避免術前誤診誤治。
목적：분석분석성소장경조림상화다층라선CT（ MSCT）영상적특정，탐토급시유효적진단조시。방법회고분석2000—2013년수술증실분석성소장경조36례적림상화MSCT자료。결과36례중남∶녀＝1∶2；농촌∶성진거민＝4∶1；28례（78％）년령＞60세。발병시간위10월지차년3월。균무상소화도수술사。림상표현복통29례（81％）；구토25례（69％）；복창19례（53％）；항문정지배기12례（33％）。발병시간1～60천（평균17천），21례（58％）수진위장경조。발병지수술시간7～73천（평균22천），술중견복수29례（81％），분석위우회장26례（72％），소장중단6례（16％），공장4례（12％）。술전복부MSCT검사29례（42인차），15례（52％）제시장경조병인（“분석”7례，“장투첩”4례，“종류”3례，“장뉴전”1례）。회고분석상복검사6인차미견분석；상、하복검사29인차2차미견분석；전복（상하복분강）검사7인차균견분석。10례증강소묘장벽균견강화，이장강내분석급변연무강화。결론분석성소장경조병인복잡림상표현무특이성，의거병사화림상표현진단곤난。전복MSCT검사병구비상응영상진단경험，가급시준학진단피면술전오진오치。
Objective To establish a more accurate diagnostic procedure for a bezoar-induced small bowel obstruction( SBO) through investigating the clinical features and the abdominal multislice spiral computed tomography ( MSCT ) findings of patients.Methods The records of 36 patients undergone operation with a diagnosis of a bezoar-induced SBO in our hospital between 2000 and 2013 were reviewed retrospectively. Results Of the 36 patients, the ratio of male to female and the rural to town residents were 1 to 2 and 4 to 1 respectively.28(78%) were over the age of 60.None had a history of upper gastrointestinal tract surgery, and all were admitted from October to March of the following year.Of clinic features, the most common one was abdominal pain (29, 81%), followed by vomiting (25, 69%), abdominal distension(19, 53%) , and no anal exhaust (12, 33%).Average time from the onset of a symptom to admission was 17 days (1 to 60 days).21 (58%) were diagnosed as SBO initially.Average time from the onset of a symptom to operation was 22 days (7 to 73 days).Surgery revealed 29(81%) cases had ascites; Bezoar locations were 26(72%) cases in ileum, 6 (16%) in mid small bowel, and 4(12%) in jejunum respectively.Of 29 patient's abdominal MSCT images (42 person-times) , 15 ( 52%) were suggested an obstruction etiology, of whom 7 were 'bezoars', 4 were 'intussusception', 2 were'tumors', and 1 was'volvulus'.When all the MSCT images were reviewed retrospectively, all 6 times upper abdominal images and 2 of 29 upper-lower abdominal ones were negative, but all were positive of 7 whole abdominal ones.Ten enhanced MSCT imaging showed bowel walls enhanced obviously contrast to the intraluminal bezoars.Conclusions A preoperative diagnosis of a bezoar-induced SBO based on history and clinical features may be difficult because of its complicated etiologies and nonspecific features.Whole abdominal MSCT imaging, associated with qualified diagnostic competence for bezaors, can lead to a more accurate diagnosis, and help to reduce unnecessary delays before appropriate surgical intervention.
