CAJ | 학술논문

目的：探讨未做肠道准备情况下结肠癌的 CT 表现特点，以提高病变检出率。方法回顾性分析因胃肠道症状就诊并进行 CT 检查的62例临床未触及包块、手术或结肠镜病理证实为结肠癌的患者资料，观察并记录各种 CT 表现特点和诊断结果，将 CT 诊断阳性率与各种征象进行统计学分析，并将肠壁外缘改变与 T 分期及其余 CT 征象进行相关分析。结果 CT 诊断阳性率为56．5％，显示管径增粗、管壁增厚、管腔狭窄、腔内隆起、外缘模糊、脂肪异常的例数分别占总数的83．9％、87．1％、38．7％、29．0％、62．9％、83．9％，62．9％的病变与邻近肠管界限清楚，24．2％可见淋巴结肿大，4．8％有远处转移，所有增强扫描病例病变肠管均呈不均匀强化。统计学分析显示：CT 诊断阳性率与肠管管径、管壁、外缘、邻近脂肪的改变，以及与周围肠管界限是否清楚及淋巴结大小等因素有关；管径增粗成块时，阳性诊断率明显增加；肠壁外缘改变与 T 分期、管径增粗、管壁增厚、脂肪异常呈正相关。结论在未做肠道准备情况下，通过仔细观察 CT 能发现大部分结肠癌并具有一定特点，其中管径增粗、管壁增厚、外缘模糊、脂肪异常对于提示结肠癌的存在有重要作用。
목적：탐토미주장도준비정황하결장암적 CT 표현특점，이제고병변검출솔。방법회고성분석인위장도증상취진병진행 CT 검사적62례림상미촉급포괴、수술혹결장경병리증실위결장암적환자자료，관찰병기록각충 CT 표현특점화진단결과，장 CT 진단양성솔여각충정상진행통계학분석，병장장벽외연개변여 T 분기급기여 CT 정상진행상관분석。결과 CT 진단양성솔위56．5％，현시관경증조、관벽증후、관강협착、강내륭기、외연모호、지방이상적례수분별점총수적83．9％、87．1％、38．7％、29．0％、62．9％、83．9％，62．9％적병변여린근장관계한청초，24．2％가견림파결종대，4．8％유원처전이，소유증강소묘병례병변장관균정불균균강화。통계학분석현시：CT 진단양성솔여장관관경、관벽、외연、린근지방적개변，이급여주위장관계한시부청초급림파결대소등인소유관；관경증조성괴시，양성진단솔명현증가；장벽외연개변여 T 분기、관경증조、관벽증후、지방이상정정상관。결론재미주장도준비정황하，통과자세관찰 CT 능발현대부분결장암병구유일정특점，기중관경증조、관벽증후、외연모호、지방이상대우제시결장암적존재유중요작용。
Objective To investigate the CT features of colon carcinoma without bowel preparation so as to improve the diagnostic accuracy .Methods 738 patients with acute abdomen presenting to the emergency department underwent CT scanning and their data were reviewed retrospectively .The CT findings of 62 patients with colon carcinoma proved by pa‐thology after surgery or colonscopy and without mass on physical examination were assessed by two observers for the pres‐ence or absence of the enlarging of the bowel ,the wall thickening ,the luminal narrowing ,the protrusion of the wall into lumen ,the misty margin ,the pericolic fat stranding ,the focalization of the lesions ,the enlargement of regional nodes and the enhancement of lesions and distant metastases .The relationship between CT detection rate and its features of colon carcinomas ,and association between the misty margin on CT images and T‐stage and other CT appearances were analyzed statistically .Results 56 .5% of patients demonstrated the lesions .There were 83 .9% (52/62) of patients with the enlar‐ging of the bowel ,87 .1% (54/62) of the wall thickening ,38 .7% (24/62) of the luminal narrowing ,29 .0% (18/62) of the protrusion of the wall into lumen ,62 .9% (39/62) of the misty margin ,83 .9% (52/62) the fat stranding ,respectively , and 62 .9% (78/124) of lesions were focal ,24 .2% (15/62) of patients had enlarged regional nodes ,4 .8% (3/62) of pa‐tients had distant metastases .All the lesions were enhanced heterogeneously .The detection rate of CT correlated with the existence of the enlarging of the bowel ,the wall thickening ,the misty margin ,the fat stranding ,the focalization of the le‐sions ,and the enlargement of nodes .The detection rate of CT increased when the enlarged bowel evolved into mass . There was a positive correlation between the misty margin and the T‐stage ,the enlarging of the bowel ,the wall thickening and the fat stranding .Conclusion CT can demonstrate most colon carcinomas even there is no bowel preparation .The en‐larging of the bowel ,the wall thickening ,the misty margin and the fat stranding play import roles in revealing the lesions .