多层螺旋CT平扫对闭合性肠及肠系膜损伤的诊断(1)
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[摘要] 目的 分析闭合性肠及肠系膜损伤的多层螺旋CT表现特征，评价其对闭合性肠及肠系膜损伤的诊断价值。 方法 回顾性分析32例经手术证实的肠及肠系膜损伤患者的多层螺旋CT表现，分析病变部位、范围、形态、密度改变，并根据Janzen方法对病变严重程度分级。 结果 肠壁增厚25例；肠系膜区脂肪呈云雾状密度增高32例；肠系膜血肿24例；腹腔、腹膜后和肠间积液、积血28例；腹腔游离积气21例。 结论 肠及肠系膜损伤的CT表现有一定的特征性，是早期诊断闭合性肠及肠系膜损伤的重要手段。
[关键词] 肠及肠系膜损伤；多层螺旋CT；X线计算机
[中图分类号] R574 [文献标识码] B [文章编号] 1673-9701(2012)06-0103-03
The diagnostic value of Multislice Spiral CT plain scan in bowel and mesenteric closed injury
LIU Ming
Department of Radiology, Dujiangyan City People′s Hospital in Sichuan Province, Dujangyan 611830, China
[Abstract] Objective To study the characteristic of bowel and mesenteric closed injury by multislice spiral computed tomography (MSCT)，and evaluate the value of MSCT in diagnosis for bowel and mesenteric closed injury. Methods All of 32 cases with bowel and mesenteric closed injury proved by surgery were analyzed retrospectively. All cases were analyzed the location, extent, form and density of the lesion, and the severity of lesion was graded according to Janzen methods. Results Twenty-five cases showed thickening bowel wall, 32 cases showed increased density in mesentery with cloudy shadow, 24 cases demonstrated mesenteric hematoma, free fluid and blood in the abdominal cavity or between the bowel was displayed in 28 cases, and free gas in the abdominal cavity was showed in 21 cases. Conclusion There are certain characteristic MSCT manifestations of bowel and mesentery trauma, and MSCT is an important method in diagnosis of bowel and mesenteric closed injury.
[Key words] Bowel and mesenteric injury; Multislice Spiral CT; X-ray computed tomography
腹部闭合伤中肠及肠系膜损伤相对少见，急诊时都注重实质脏器的损伤，而忽略了肠及肠系膜损伤。但是损伤容易导致肠穿孔、继发肠坏死、腹膜炎、感染性休克和肠系膜血管破裂大出血休克，故早期诊断非常重要，可以提高腹部创伤的治愈率、降低死亡率。多层螺旋CT快速、薄层、大范围的扫描为腹部肠及肠系膜损伤诊断提供了保障。本文收集我院32例经手术证实的肠及肠系膜损伤患者资料，分析其CT表现，旨在提高CT诊断准确率，对临床治疗方案提供有力的诊断依据，现报道如下。
1 资料与方法
1.1 一般资料
收集我院2010年5月～2011年10月急诊腹部闭合性外伤32例经手术证实的肠及肠系膜损伤患者的CT资料。其中男26例，女6例，年龄16～72岁，平均44岁。32例均有明确腹部外伤史，包括车祸伤18例、高处坠落3例、挤压伤及打击伤11例。临床主要表现为腹部疼痛，疼痛呈渐进性加重，肌紧张，板状腹，休克症状。
1.2 检查方法
使用GE公司Lightspeed16层螺旋CT机，扫描范围自膈顶至耻骨联合上缘。所有患者均采用螺旋容积扫描，120 kV、90 mAs，层厚10 mm，薄层重建厚度1.25 mm、MPR重建。本组32例患者术前均行CT平扫，薄层重建、MPR重建，采用多窗技术观察(窗宽250 HU，窗位50～70 HU；窗宽1500 HU，窗位-700 HU；窗宽600 HU，窗位-50 HU) ......
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