CAJ | 학술논문

目的：探讨多层螺旋CT （multi‐slice spiralCT ，MSCT ）及电子肠镜对结肠Crohn病诊断价值及其限度。方法回顾性分析经手术、病理、临床证实的结肠Crohn病的MSCT及电子肠镜的表现，重点评价两种方法对病变的显示情况。结果17例M SC T检查，多节段病变17例（100％），病变仅累及结肠8例（47．1％），同时累及结肠和小肠9例（52．9％），共累及57个结肠段，表现为肠壁增厚（＞4mm）17例（100％），强化增加（＞20HU ）17例（100％），肠腔不规则狭窄6例（35．3％），系膜区淋巴结肿大（＞5mm）13例（76．5％），肠系膜血管增多（梳征）16例（94．1％），肠管周围蜂窝织炎7例（41．2％），腹腔内脓肿1例（5．9％），腹腔积液5例（29．4％），瘘管1例（5．9％）。16例电子肠镜检查，表现为裂隙状溃7例（43．8％），铺路石征10例（62．5％），肠腔狭窄7例（43．8％），多节段性病变15例（93．8％）。结论结肠Crohn病的M SC T表现有一定特征性，可多方位观察肠壁、肠周病变，但难以显示肠内裂隙状溃疡和铺路石征。电子肠镜易于显示黏膜纵行裂隙状溃疡和铺路石征等特征性改变，但不能显示肠壁病变及肠周并发症。两种检查方法相互结合，可提高结肠Crohn的诊断率。
목적：탐토다층라선CT （multi‐slice spiralCT ，MSCT ）급전자장경대결장Crohn병진단개치급기한도。방법회고성분석경수술、병리、림상증실적결장Crohn병적MSCT급전자장경적표현，중점평개량충방법대병변적현시정황。결과17례M SC T검사，다절단병변17례（100％），병변부루급결장8례（47．1％），동시루급결장화소장9례（52．9％），공루급57개결장단，표현위장벽증후（＞4mm）17례（100％），강화증가（＞20HU ）17례（100％），장강불규칙협착6례（35．3％），계막구림파결종대（＞5mm）13례（76．5％），장계막혈관증다（소정）16례（94．1％），장관주위봉와직염7례（41．2％），복강내농종1례（5．9％），복강적액5례（29．4％），루관1례（5．9％）。16례전자장경검사，표현위렬극상궤7례（43．8％），포로석정10례（62．5％），장강협착7례（43．8％），다절단성병변15례（93．8％）。결론결장Crohn병적M SC T표현유일정특정성，가다방위관찰장벽、장주병변，단난이현시장내렬극상궤양화포로석정。전자장경역우현시점막종행렬극상궤양화포로석정등특정성개변，단불능현시장벽병변급장주병발증。량충검사방법상호결합，가제고결장Crohn적진단솔。
Objective To investigate the value and limits of MSCT and electronic colonoscope in the diagnosis of Crohn’ s disease of colon .Methods MSCT and electronic electronic colonoscope date of colon Crohn’s disease ,which were prov‐en by surgery ,pathology and clinic ,were retrospectively analysed .Both methods focused on the evaluation of the lesion display .Results Of the 17 cases of MSCT ,17 cases (100% ) showed multi‐segment lesions ,8 cases (41 .7% ) had lesions limited in colon ,9 cases (52 .9% ) had simultaneous colon and small intestine involvement .There were a total of 57 seg‐ments of colon involved .Among the 17 cases ,there were 17 cases (100% ) of mural thickening (> 4 mm) ,17 cases (100% ) of increased enhancement of bowel wall (>20~30 HU) ,6 cases (35 .3% ) of irregular intestine stenosis ,13 ca‐ses (76.5% ) of mesangial region lymphadenectasis (> 5 mm ) ,16 cases (94 .1% ) of increased mesenteric vascularity (“comb”sign) ,7 cases (41 .2% ) of dermatocellulitis ,1 case (5 .9% ) of peritoneal abscess ,5 cases (29 .4% ) of seroper‐itoneum ,1 case (5 .9% ) of fistulization .Among the 16 cases of electronic colonoscope ,7 cases (43 .8% ) of strip ucers , 10 cases (62.5% ) of cobblestone ,there were 7 cases (43 .8 .7% ) of intestine stenosis ,15 cases (93 .8% ) of skip lesions . Conclusion The MSCT findings of colonic Crohn’s disease are characteristic ,which have advantages in demonstrating bowel wall and extraintestinal complication of Crohn’s disease ,but cann’t demonstrate strip ucers and cobblestone .The electronic colonoscope is easy to demonstrate the characteristic changes of Crohn’s disease such as strip ucers and cobble‐stones ,but it is difficult to demonstrate bowel Wall and extraintestinal complication .The two diagnosic methods are com‐bined ,which can improve the diagnosis of Crohn’s disease of Colon .