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目的对照手术或病理结果,回顾性研究确定CT诊断在急性肠梗阻合并肠缺血的价值。方法收集5年时间内共142例小肠梗阻病人,144次CT扫描资料。由二名放射医生共同分析CT表现。着重分析下列肠缺血的CT征象:肠壁的强化减弱,肠壁增厚,肠系膜积液,肠系膜静脉扩张与腹水。一旦发现肠壁强化减弱,或具备另外二条以上CT征象,即可诊断肠缺血。CT结果73例与外科手术对照,71例临床追踪证实。结果24例手术发现肠缺血。其中23例CT诊断正确(敏感性96%)。假阳性9例(特异性93%)。肠壁强化减弱征象的敏感性48%,特异性为100%。肠壁增厚敏感性38%,特异性78%,肠系膜积液的敏感性88%,特异性90%。肠系膜静脉扩张的敏感性58%,特异性为79%,腹水的敏感性75%,特异性76%。结论螺旋CT是诊断急性肠梗阻合并肠缺血的敏感方法。
Objective To compare the value of surgical or pathological findings with that of CT in the diagnosis of acute intestinal obstruction complicated by intestinal ischemia. Methods A total of 142 patients with small intestinal obstruction and 144 CT scans were collected during 5 years. Two radiologists analyzed CT findings together. Focus on the following CT signs of intestinal ischemia: Intestinal weakening, thickening of the intestinal wall, mesenteric effusion, mesenteric vein dilatation and ascites. Intestinal ischemia can be diagnosed once the bowel wall is found to have weakened or with more than two other CT signs. 73 cases of CT and surgical control, 71 cases of clinical follow-up confirmed. Results 24 cases of intestinal ischemia found surgery. 23 of them were correctly diagnosed by CT (96% sensitivity). False positive in 9 cases (93% specificity). Intestinal wall weakening signs of 48% sensitivity, specificity of 100%. Sensitivity of intestinal wall thickening 38%, specificity 78%, mesenteric effusion 88% sensitivity, specificity 90%. Sensitivity of mesenteric vein dilatation 58%, specificity of 79%, ascites sensitivity 75%, specificity 76%. Conclusion Spiral CT is a sensitive method to diagnose acute intestinal obstruction and intestinal ischemia.