ＣＴ在胃肠道穿孔定位诊断中的价值

【摘要】 目的 探讨CT在胃肠道穿孔定位诊断中的价值。方法 对16例成人胃肠道穿孔患者进行回顾性分析。结果 16例患者中，胃、十二指肠球部穿孔9例，十二指肠腹膜后段穿孔1例，空回肠穿孔4例，阑尾炎穿孔1例，结肠癌伴穿孔1例。CT表现为:气腹、腹膜腔及腹膜后间隙积液、穿孔部位局限性肠壁增厚和周围脂肪间隙模糊。结论 CT不仅能确定有无胃肠道穿孔，而且能初步判断其穿孔部位。其中局限性肠壁增厚及周围脂肪间隙密度增高、邻近腹腔、腹膜后间隙积液为诊断穿孔部位较为特异性的征象。

【关键词】胃肠穿孔；体层摄影术

Value of CT in predicting site of gastrointestinal tract perforation

YANG Wei.Department of CT,Guizhou Hospital,Zunyi ,China

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【Abstract】 Objective To discuss CT examination in predicting site of gastrointestinal tract perforation.Methods All CT data of 16 adult patients with gastrointestinal tract perforation were reviewed retrospectively.Results Of the 16 cases,9 had stomach or duodenal bulb perforations,1 had retroperitoneal duodenum perforation，4 had jejunoileum perforations，1 had perforated appendicitis and 1 had perforated colon carcinoma.The prediction of the site of gastrointestinal tract perforation using the following CT findings:Pneumoperitoneum,Segmental bowel-wall thickening,Perivisceral peritoneal cavity or retroperitoneal space fluid and fat stranding.Conclusion CT examination can discover whether there is perforation or not and predict the site of gastrointestinal tract perforations.Segmental bowel-wall thickening,perivisceral peritoneal cavity or retroperitoneal space fluid and fat stranding are significant findings to predict the site of gastrointestinal tract perforations.

【Key words】Gastrointestinal tract perforation; Tomography

胃肠道穿孔是常见急腹症，临床上常需要立即进行外科手术。正确的诊断往往依赖于影像学检查。口服造影剂可能会加重胃肠道穿孔患者病情。而且肠穿孔患者常有肠麻痹，肠蠕动慢，造影剂推动慢，对远段肠道穿孔病例诊断不理想。另外，CT检查一般为仰卧位，口服造影剂只对部分后壁穿孔有效。

以往对胃肠道穿孔CT诊断的文献往往把重点放在其CT表现上，对穿孔部位的诊断却鲜有提及。结合本组16例患者及实际工作经验，笔者认为，CT不仅能确定有无胃肠道穿孔，而且能初步判断其穿孔部位，为手术医师提供重要的临床信息以确定手术方案。其中局限性肠壁增厚、穿孔肠道周围脂肪间隙密度增高及邻近腹腔、腹膜后间隙积液为诊断穿孔部位较为特异性征象。

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