多层螺旋CT在小肠疾病诊断中的应用研究
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摘要
研究目的：
小肠慢性出血性疾病发病率低,起病隐匿,症状特异性不强且病变部位深而不固定,而且由于小肠肠管互相重叠,走行弯曲,不断蠕动,所以小肠慢性出血性疾病的诊断目前仍是临床实践中的一个难点。多层螺旋CT小肠成像具有多通道的快速采集、单次扫描覆盖范围大、单次静脉注射碘对比剂可得到多期相图像及强大的图像后处理功能等优点,能清晰反映肠壁和肠腔内外病变及远隔脏器的病变。而如何评价CT小肠成像在小肠疾病中的诊断价值,是在临床工作中经常面临的难题。本研究将CT小肠成像在小肠慢性出血性疾病中的诊断结果与小肠镜活检及临床手术病理进行对比,评价CT小肠成像在小肠慢性出血性疾病诊断中的应用价值。
研究方法：
回顾性研究我院2010年7月至2012年7月30例有明确诊断结果的小肠慢性出血性的病例,该组病例均有肠镜结果、活检和/或临床手术病理。纳入标准为患者均实行过CT小肠成像和小肠镜检查的慢性消化道出血病例。排除标准为消化道急性出血及临床表现为急腹症的患者。CT小肠成像检查通过引入等渗甘露醇对比剂,分次口服后,充盈全组小肠,应用GE公司Lightspeed64层螺旋CT行全腹平扫+增强扫描,分析小肠肠壁的增厚情况、肠黏膜强化程度、肠壁有无分层、肠腔是否狭窄、腹主动脉及肠系膜上动静脉强化情况,肠系膜血管分布情况,进而做出CT小肠成像的影像诊断。小肠镜检查采用东芝公司Olympus小肠镜,分为经口和经肛小肠镜检查,一般先行经肛小肠镜,通过反复拉钩达空肠中段。若发现病变则不再行经口小肠镜,经口小肠镜在复合麻醉下经口进入,一般达空肠中下段。将两种方法诊断的小肠病变的部位、性质通过参照小肠镜检查结果和临床病理结果进行对比。
结果：
30例小肠慢性出血性疾病中,肿瘤性疾病17例,血管性疾病3例,炎症性疾病4例,其他类疾病6例。CT小肠成像发现病变的临床准确率为80%(24/30),而小肠镜发现病变的临床准确率为90%(27/30)。CT小肠成像遗漏的病变分别为小肠憩室1例,原因可能为小肠走行迂曲,且憩室同小肠壁正常结构相同,CT小肠成像未能发现该病变；毛细血管扩张症1例,单纯性小肠粘膜充血水肿1例,嗜酸性小肠炎1例,小肠小的息肉病变2例,遗漏原因可能为扩张的毛细血管细小,小的息肉与肠粘膜难以区分,单纯性小肠粘膜充血水肿及嗜酸性小肠炎病变程度较轻,小肠CT小肠成像未能发现病变。而小肠镜未发现或部分遗漏3例病变中,间质瘤一例,动静脉畸形(AVM)一例,小肠憩室合并感染一例,3例病变均位于空回肠交界处,因小肠镜需经口和经肛检查,两次小肠镜检查结果可能未能对接,故遗漏该处病变。二者在诊断准确率方面差异比较无统计学意义(P=0.6876>0.05)；而CT小肠成像在全组小肠充盈对比剂后,对小肠的全貌显示具有优势,而小肠镜在诊断小肠微小病变方面具有优势,因此二者在诊断小肠慢性出血性疾病中能够互补。
结论：
在小肠出血性疾病的诊断中,小肠镜在诊断小肠细小病变方面具有优势,而由肿瘤性疾病引起小肠慢性出血的病例中,CTE能够部分替代小肠镜检查,CTE在诊断空回肠交界处病变具有优势,能够补充小肠的检查,并且具有检查费用低,病人痛苦小和容易操作等优点。因此在诊断小肠慢性出血性疾病方面,CTE是一种非常有效的技术手段。
研究目的：
小肠梗阻不仅可以引起肠管本身解剖和功能上的改变,还可导致全身性生理上的紊乱,且临床表现复杂多变。对小肠梗阻提供有效治疗主要取决于快速和准确的诊断,以往影像学检查主要靠X线腹部摄片,但伴随着急诊CT的广泛开展,CT已成为明确肠梗阻位置、形态以及病因诊断的主要检查手段之一。CT被认为是确定哪些患者适于保守治疗和密切随访,而哪些患者适于立即进行手术治疗的最佳方式,本研究通过回顾性分析经手术或临床证实的30例小肠梗阻患者,探讨小肠梗阻的多层螺旋CT诊断特点。
研究方法：
收集我院2011年1月-2012年7月经手术或临床证实的小肠梗阻病例30例,其中男18例,女性12例,年龄31岁-77岁,平均年龄52岁。临床表现为腹痛、腹胀、呕吐、黑便及停止排气排便等,其中既往有手术史8例,外伤史1例。采用美国通用电气公司GE64层螺旋CT,取仰卧位检查,一次屏气下从膈面开始连续螺旋扫描至耻骨联合水平,螺距为1,层厚5mm,工作站为美国通用电气公司的ADW4.3工作站,必要时采用多平面重建(MPR)、曲面重建(CPR)、容积再现技术(VRT)和最大密度投影(MIP)等多种处理方法进行图像重建。由于本组患者临床禁食、行胃肠减压,或以急诊进行检查,并且肠梗阻患者肠管内大量液体和气体形成良好的自然对比,基本等同于CTE检查,因为本组患者耐受力差,故在患者能耐受的前提下,只有5例口服等渗甘露醇对比剂。该组检查中临床可疑血运障碍者行平扫+增强扫描,共计8例。
结果：
1.有无梗阻：30例病例中,CT检查有无梗阻的敏感性为100%。CT表现为肠管呈节段性或普遍性扩张、积液、积气,扩张小肠内径大于2.5cm,其中22例能良好显示移行带。2.梗阻定位：根据诊断标准并借助于多平面重建,诊断其中高位梗阻11例,低位梗阻19例,与手术或临床证实的高位梗阻14例,低位梗阻16例相比,误诊3例,定位诊断的准确率达90%。3.梗阻病因：病因诊断正确率86.7%,30例病例中,手术病理或临床证实粘连性肠梗阻13例,肿瘤性肠梗阻8例,肠套叠所致的肠梗阻4例(包括肿瘤所致肠套叠2例),血运性肠梗阻3例,内疝伴肠扭转1例,外伤后肠梗阻1例,肠外肿瘤压迫致肠梗阻2例。误诊4例,其中2例粘连性诊断为肿瘤性肠梗阻,1例内疝诊断为肠系膜扭转,1例回盲部脂肪瘤伴肠套叠仅诊断为肠套叠。不同的梗阻原因CT表现也各有不同,其中粘连所致肠梗阻中,有梗阻近端肠管扩张和远端肠管塌陷表现者10例,表现鸟嘴征者2例,局部粘连束带征者9例；肿瘤所致肠梗阻中,梗阻部位可见软组织肿块或肠壁不均匀增厚者5例,肿瘤所致肠套叠进而引起肠梗阻者2例,伴有临近肠系膜处的淋巴结肿大或肝内转移者4例；肠套叠所致肠梗阻中,均可见到肠腔同心圆样改变,内见低密度系膜卷入其中。
结论：
多层螺旋CT诊断小肠梗阻阳性率达到100%,诊断小肠梗阻的病因和梗阻部位均具有高度敏感性,因而多层螺旋CT是诊断小肠肠梗阻的有效方法：而对小肠梗阻的CT征象的较好理解和认真分析有助于提高诊断准确性并帮助临床及时制定治疗方案。
Objective:The incidence of small intestine chronic hemorrhagic diseases is at a low rate and the causes and symptoms for these diseases are hard to define. Besides, the tortuous intestine tubes are often overlapping and wriggling. All the factors mentioned above made it difficult for the diagnosis of small intestine diseases in clinical practice. By contrast, the MSCTE is characterized by the following advantages. The image can be quickly made through multi-channels, the scope of a single scanning is wide, many images can be made through one single intravenous injection and they will be handled effectively thereafter. All these advantages will make it easy for the lesion of the intestinal wall, the lesion outside the gut cavity and the lesion far away from the visceral organs to be seen. This paper will make a comparison between the CT enterography (CTE) in the diagnosis of small intestine chronic hemorrhagic diseases and the endoscope and the clinical surgical pathology, which will show the value of the CT enterography (CTE) in the diagnosis.
Methods:A retrospective study was made on30patients who were diagnosed as patients of small intestine chronic hemorrhagic diseases during a time span of two years from July2012to July2012. All the patients in this group were examined by both the small intestinal endoscope and biopsy or clinical surgical pathology. The reason for the patients to be taken as subjects is that they were examined by both the CTE and the small intestinal endoscope. The exclusion criterion is acute hemorrage dieases and acute abdomen patients. In CTE inspection, isotonic mannitol was taken orally for several times by the patients. With the isotonic mannitol full of the small intestine, patients were examined by the GE Lightspeed64-slices spiral CT. Both total abdominal plain scan and enhancement scan are applied to observe the intestinal wall thickening, the reinforcement degree of the intestinal mucosa, intestinal wall stratification, stricture of the gut cavity, strengthening of abdominal aorta and of the artery and vein in the mesentery, and the distribution of the vessels in the mesentery. All these mentioned above will make the imaging diagnosis based on the CTE possible. Small intestinal endoscope examination was made by Toshiba Olympus endoscope. Endoscope of the small intestine can be divided into two kinds. One is taken through the mouth, the other the anus. Usually the one through the anus is taken first. By repeated dragging and hooking, it will reach the middle and lower part of the small intestine. If a lesion is found, there is no need to take the endoscope through the mouth. Otherwise, after combined anesthesia, the patients will be examined by the endoscope through the mouth, which will usually reach the middle and lower part of the small intestine. Then a conclusion of the position and attributes of the lesion will come after comparing and contrasting the two methods and the clinical pathology results.
Results:Among the30patients, tumors17and arterialvenous malformation diseases3,and inflammatory diseases4,and another6cases.the precision rate of defining the lesion by the CTE is80%(24/30), while the precision rate by the small intestine endoscope is90%(27/30). The lesions neglected by the CTE include one cases of small intestine diverticular, one case of capillary telangiectasia, one cases of small intestinal mucosa congestion edema, one cases of eosinophils inflammation of the intestinal tract, and2cases of small polyp in the intestinal tract。The reason for the neglect of the small intestine diverticular is that the small intestine is circular and it has similar structure to that of the small intestine diverticular; the reason for the neglect of capillary telangiectasia and small intestinal mucosa congestion edema might be that the dilation of the capillary and the congestion edema is slight, thus making it hard to be discovered by the CTE. Among the3cases which were neglected or undiscovered, one is small intestine stromal tumor, one is arteriovenous malformation, and one is concurrent infection of the small intestine diverticular. All these three lesion located at the jejuno-ileum. The reason for the neglect might be that the endoscope through the mouth and the anus didn't meet, thus making it neglected. The differences between the two methods of examination in accurate diagnosis didn't have statistical meaning (P=0.6876>0.05). With the help of the isotonic mannitol, the CTE shows its advantage in displaying the small intestine, while the endoscope shows its advantage in diagnosing tiny lesion of small intestine. To conclude, the two methods can complement with each other in diagnosis of small intestine chronic hemorrhagic diseases.
Conclusion:CTE can complement or replace the endoscope in diagnosing small intestine hemorrhagic diseases. What's more, it is better in diagnosing the lesion in the jejuno-ileum than the endoscope. In particular, it is cheaper and easy to operate and cause less pain to the patients. Therefore, CTE is an effective method in diagnosing small intestine hemorrhagic diseases.
Objective:Small bowel obstruction can cause the change of dissection and function in the intestinal tube as well as physicadisturbance on the body. Besides, the clinical manifestation is very complicated and changeable. The effective treat of the small bowel obstruction mainly depends on the quick and correct diagnosis. Previously, the iconography examination mainly depends on the X-ray abdominal radiography. But with the development of CT, it has become the main method in determining the position, the shape and the causes of the intestine obstruction. CT is regarded as the best way to know whether patients need expectant treatment or close follow-up or they should receive immediate operation treatment. This paper tries to analyze the characteristics of multi-slice computed tomography diagnosis in the small bowel obstruction through the analysis of30cases of small bowel obstruction confirmed by clinical diagnosis and operation.
Methods:Collect30cases of small bowelobstruction clinical or operation confirmed from January,2011to July,2012in our hospital, among which include18males and12females. Their ages are between31to77, and the average age is52. The clinical manifestations are abdominal pain, abdominal distension, vomit, melena, and the stopping of exhaust defecation. Among these cases, there are8ones which have previous operation and1case which has previous external injury. The flight lead should be1while the slice thickness should be5mm. Because the patients of this group should have clinical fasting, gastrointestinal decompression, or they receive emergency treatment, so they didn't take contrast agent, and the small bowel contents can act as the natural contrast agent,so only5cases taked isotonic solution of manicol liquid. There are22cases which have received plain scan and8cases which receive plain and enhancement scan.
Results:
1. The existence of obstruction:the sensibility of CT is100%in these30cases. Intestinal tube has segmental or universal expansion, effusion, pneumatosis, and the expansion of small intestine diameter is over2.5cm, and22cases among these have positive transitional zone.
2. The determination of the obstruction:According to the standards of diagnosis and depending on multi-planar reconstruction, there are11high obstructions,19low obstructions. While the result of operation or clinical confirmed result is14high obstructions and16low obstructions, there are3cases of misdiagnosis, and the accuracy rate is90%.
3. The causes of obstruction:the accuracy rate of the causes of the disease is86.7%. In the30cases, there are12cases of pathologically or clinically confirmed adhesive obstruction,8neoplastic obstruction,3intussusceptions obstruction (including2ones caused by neoplastic obstruction),3intestinal twist obstruction,2cases caused by the blood supply,1case caused by internal heynia,l external injury,2tumor suppressor obstruction. There are4misdiagnosis, among which include2cases which misdiagnose adhesive obstruction as neoplastic obstruction,1internal heynia obstruction as mesentery twist,1ileocecal junction lipoma intussusceptions as intussusceptions. The obstruction caused by different reasons has different manifestation in the CT. In the adhesive obstruction, there are10cases of the sink of the proximal intestine and intestinal tube expansion of the distal intestine,2cases of angle sign,9partial adhesive band syndromes. In the obstruction caused by tumor, there are5cases in which soft tissue mass or uneven thickening of the intestinal wall can be seen in the position of obstruction. There are2cases of obstruction caused by intussusceptions which in turn is caused by tumor. There are4cases of lymphadenovarix near the mesentery or intrahepatic metastasis. In the obstruction caused by intussusceptions, the circle-like change in the enteric cavity and the entanglement of low density y mesentery can be seen. All in all, in these cases examined by the multi-slice computed tomography, the sensitivity of the examination is100%and the accuracy of determination of the position is91%, the cause of the desease is86%. The CT manifestation of small bowel obstruction is that intestinal tube has segmental or universal expansion, effusion, pneumatosis. Different reasons have different manifestations in CT.
Conclusion:the positive rate can reach100%in the diagnosis of small intestine obstruction by using multi-slice computed tomography. it has also high sensitivity in determining the causes and positions of obstruction, so multi-slice computed tomography is an very effective way. A better understanding and careful analysis of small bowel obstruction in the CT manifestation is very helpful in accurate diagnosis, and thus an immediate clinical decision can be made.
小肠慢性出血性疾病发病率低,起病隐匿,症状特异性不强且病变部位深而不固定,而且由于小肠肠管互相重叠,走行弯曲,不断蠕动,所以小肠慢性出血性疾病的诊断目前仍是临床实践中的一个难点。多层螺旋CT小肠成像具有多通道的快速采集、单次扫描覆盖范围大、单次静脉注射碘对比剂可得到多期相图像及强大的图像后处理功能等优点,能清晰反映肠壁和肠腔内外病变及远隔脏器的病变。而如何评价CT小肠成像在小肠疾病中的诊断价值,是在临床工作中经常面临的难题。本研究将CT小肠成像在小肠慢性出血性疾病中的诊断结果与小肠镜活检及临床手术病理进行对比,评价CT小肠成像在小肠慢性出血性疾病诊断中的应用价值。
研究方法：
回顾性研究我院2010年7月至2012年7月30例有明确诊断结果的小肠慢性出血性的病例,该组病例均有肠镜结果、活检和/或临床手术病理。纳入标准为患者均实行过CT小肠成像和小肠镜检查的慢性消化道出血病例。排除标准为消化道急性出血及临床表现为急腹症的患者。CT小肠成像检查通过引入等渗甘露醇对比剂,分次口服后,充盈全组小肠,应用GE公司Lightspeed64层螺旋CT行全腹平扫+增强扫描,分析小肠肠壁的增厚情况、肠黏膜强化程度、肠壁有无分层、肠腔是否狭窄、腹主动脉及肠系膜上动静脉强化情况,肠系膜血管分布情况,进而做出CT小肠成像的影像诊断。小肠镜检查采用东芝公司Olympus小肠镜,分为经口和经肛小肠镜检查,一般先行经肛小肠镜,通过反复拉钩达空肠中段。若发现病变则不再行经口小肠镜,经口小肠镜在复合麻醉下经口进入,一般达空肠中下段。将两种方法诊断的小肠病变的部位、性质通过参照小肠镜检查结果和临床病理结果进行对比。
结果：
30例小肠慢性出血性疾病中,肿瘤性疾病17例,血管性疾病3例,炎症性疾病4例,其他类疾病6例。CT小肠成像发现病变的临床准确率为80%(24/30),而小肠镜发现病变的临床准确率为90%(27/30)。CT小肠成像遗漏的病变分别为小肠憩室1例,原因可能为小肠走行迂曲,且憩室同小肠壁正常结构相同,CT小肠成像未能发现该病变；毛细血管扩张症1例,单纯性小肠粘膜充血水肿1例,嗜酸性小肠炎1例,小肠小的息肉病变2例,遗漏原因可能为扩张的毛细血管细小,小的息肉与肠粘膜难以区分,单纯性小肠粘膜充血水肿及嗜酸性小肠炎病变程度较轻,小肠CT小肠成像未能发现病变。而小肠镜未发现或部分遗漏3例病变中,间质瘤一例,动静脉畸形(AVM)一例,小肠憩室合并感染一例,3例病变均位于空回肠交界处,因小肠镜需经口和经肛检查,两次小肠镜检查结果可能未能对接,故遗漏该处病变。二者在诊断准确率方面差异比较无统计学意义(P=0.6876>0.05)；而CT小肠成像在全组小肠充盈对比剂后,对小肠的全貌显示具有优势,而小肠镜在诊断小肠微小病变方面具有优势,因此二者在诊断小肠慢性出血性疾病中能够互补。
结论：
在小肠出血性疾病的诊断中,小肠镜在诊断小肠细小病变方面具有优势,而由肿瘤性疾病引起小肠慢性出血的病例中,CTE能够部分替代小肠镜检查,CTE在诊断空回肠交界处病变具有优势,能够补充小肠的检查,并且具有检查费用低,病人痛苦小和容易操作等优点。因此在诊断小肠慢性出血性疾病方面,CTE是一种非常有效的技术手段。
研究目的：
小肠梗阻不仅可以引起肠管本身解剖和功能上的改变,还可导致全身性生理上的紊乱,且临床表现复杂多变。对小肠梗阻提供有效治疗主要取决于快速和准确的诊断,以往影像学检查主要靠X线腹部摄片,但伴随着急诊CT的广泛开展,CT已成为明确肠梗阻位置、形态以及病因诊断的主要检查手段之一。CT被认为是确定哪些患者适于保守治疗和密切随访,而哪些患者适于立即进行手术治疗的最佳方式,本研究通过回顾性分析经手术或临床证实的30例小肠梗阻患者,探讨小肠梗阻的多层螺旋CT诊断特点。
研究方法：
收集我院2011年1月-2012年7月经手术或临床证实的小肠梗阻病例30例,其中男18例,女性12例,年龄31岁-77岁,平均年龄52岁。临床表现为腹痛、腹胀、呕吐、黑便及停止排气排便等,其中既往有手术史8例,外伤史1例。采用美国通用电气公司GE64层螺旋CT,取仰卧位检查,一次屏气下从膈面开始连续螺旋扫描至耻骨联合水平,螺距为1,层厚5mm,工作站为美国通用电气公司的ADW4.3工作站,必要时采用多平面重建(MPR)、曲面重建(CPR)、容积再现技术(VRT)和最大密度投影(MIP)等多种处理方法进行图像重建。由于本组患者临床禁食、行胃肠减压,或以急诊进行检查,并且肠梗阻患者肠管内大量液体和气体形成良好的自然对比,基本等同于CTE检查,因为本组患者耐受力差,故在患者能耐受的前提下,只有5例口服等渗甘露醇对比剂。该组检查中临床可疑血运障碍者行平扫+增强扫描,共计8例。
结果：
1.有无梗阻：30例病例中,CT检查有无梗阻的敏感性为100%。CT表现为肠管呈节段性或普遍性扩张、积液、积气,扩张小肠内径大于2.5cm,其中22例能良好显示移行带。2.梗阻定位：根据诊断标准并借助于多平面重建,诊断其中高位梗阻11例,低位梗阻19例,与手术或临床证实的高位梗阻14例,低位梗阻16例相比,误诊3例,定位诊断的准确率达90%。3.梗阻病因：病因诊断正确率86.7%,30例病例中,手术病理或临床证实粘连性肠梗阻13例,肿瘤性肠梗阻8例,肠套叠所致的肠梗阻4例(包括肿瘤所致肠套叠2例),血运性肠梗阻3例,内疝伴肠扭转1例,外伤后肠梗阻1例,肠外肿瘤压迫致肠梗阻2例。误诊4例,其中2例粘连性诊断为肿瘤性肠梗阻,1例内疝诊断为肠系膜扭转,1例回盲部脂肪瘤伴肠套叠仅诊断为肠套叠。不同的梗阻原因CT表现也各有不同,其中粘连所致肠梗阻中,有梗阻近端肠管扩张和远端肠管塌陷表现者10例,表现鸟嘴征者2例,局部粘连束带征者9例；肿瘤所致肠梗阻中,梗阻部位可见软组织肿块或肠壁不均匀增厚者5例,肿瘤所致肠套叠进而引起肠梗阻者2例,伴有临近肠系膜处的淋巴结肿大或肝内转移者4例；肠套叠所致肠梗阻中,均可见到肠腔同心圆样改变,内见低密度系膜卷入其中。
结论：
多层螺旋CT诊断小肠梗阻阳性率达到100%,诊断小肠梗阻的病因和梗阻部位均具有高度敏感性,因而多层螺旋CT是诊断小肠肠梗阻的有效方法：而对小肠梗阻的CT征象的较好理解和认真分析有助于提高诊断准确性并帮助临床及时制定治疗方案。
Objective:The incidence of small intestine chronic hemorrhagic diseases is at a low rate and the causes and symptoms for these diseases are hard to define. Besides, the tortuous intestine tubes are often overlapping and wriggling. All the factors mentioned above made it difficult for the diagnosis of small intestine diseases in clinical practice. By contrast, the MSCTE is characterized by the following advantages. The image can be quickly made through multi-channels, the scope of a single scanning is wide, many images can be made through one single intravenous injection and they will be handled effectively thereafter. All these advantages will make it easy for the lesion of the intestinal wall, the lesion outside the gut cavity and the lesion far away from the visceral organs to be seen. This paper will make a comparison between the CT enterography (CTE) in the diagnosis of small intestine chronic hemorrhagic diseases and the endoscope and the clinical surgical pathology, which will show the value of the CT enterography (CTE) in the diagnosis.
Methods:A retrospective study was made on30patients who were diagnosed as patients of small intestine chronic hemorrhagic diseases during a time span of two years from July2012to July2012. All the patients in this group were examined by both the small intestinal endoscope and biopsy or clinical surgical pathology. The reason for the patients to be taken as subjects is that they were examined by both the CTE and the small intestinal endoscope. The exclusion criterion is acute hemorrage dieases and acute abdomen patients. In CTE inspection, isotonic mannitol was taken orally for several times by the patients. With the isotonic mannitol full of the small intestine, patients were examined by the GE Lightspeed64-slices spiral CT. Both total abdominal plain scan and enhancement scan are applied to observe the intestinal wall thickening, the reinforcement degree of the intestinal mucosa, intestinal wall stratification, stricture of the gut cavity, strengthening of abdominal aorta and of the artery and vein in the mesentery, and the distribution of the vessels in the mesentery. All these mentioned above will make the imaging diagnosis based on the CTE possible. Small intestinal endoscope examination was made by Toshiba Olympus endoscope. Endoscope of the small intestine can be divided into two kinds. One is taken through the mouth, the other the anus. Usually the one through the anus is taken first. By repeated dragging and hooking, it will reach the middle and lower part of the small intestine. If a lesion is found, there is no need to take the endoscope through the mouth. Otherwise, after combined anesthesia, the patients will be examined by the endoscope through the mouth, which will usually reach the middle and lower part of the small intestine. Then a conclusion of the position and attributes of the lesion will come after comparing and contrasting the two methods and the clinical pathology results.
Results:Among the30patients, tumors17and arterialvenous malformation diseases3,and inflammatory diseases4,and another6cases.the precision rate of defining the lesion by the CTE is80%(24/30), while the precision rate by the small intestine endoscope is90%(27/30). The lesions neglected by the CTE include one cases of small intestine diverticular, one case of capillary telangiectasia, one cases of small intestinal mucosa congestion edema, one cases of eosinophils inflammation of the intestinal tract, and2cases of small polyp in the intestinal tract。The reason for the neglect of the small intestine diverticular is that the small intestine is circular and it has similar structure to that of the small intestine diverticular; the reason for the neglect of capillary telangiectasia and small intestinal mucosa congestion edema might be that the dilation of the capillary and the congestion edema is slight, thus making it hard to be discovered by the CTE. Among the3cases which were neglected or undiscovered, one is small intestine stromal tumor, one is arteriovenous malformation, and one is concurrent infection of the small intestine diverticular. All these three lesion located at the jejuno-ileum. The reason for the neglect might be that the endoscope through the mouth and the anus didn't meet, thus making it neglected. The differences between the two methods of examination in accurate diagnosis didn't have statistical meaning (P=0.6876>0.05). With the help of the isotonic mannitol, the CTE shows its advantage in displaying the small intestine, while the endoscope shows its advantage in diagnosing tiny lesion of small intestine. To conclude, the two methods can complement with each other in diagnosis of small intestine chronic hemorrhagic diseases.
Conclusion:CTE can complement or replace the endoscope in diagnosing small intestine hemorrhagic diseases. What's more, it is better in diagnosing the lesion in the jejuno-ileum than the endoscope. In particular, it is cheaper and easy to operate and cause less pain to the patients. Therefore, CTE is an effective method in diagnosing small intestine hemorrhagic diseases.
Objective:Small bowel obstruction can cause the change of dissection and function in the intestinal tube as well as physicadisturbance on the body. Besides, the clinical manifestation is very complicated and changeable. The effective treat of the small bowel obstruction mainly depends on the quick and correct diagnosis. Previously, the iconography examination mainly depends on the X-ray abdominal radiography. But with the development of CT, it has become the main method in determining the position, the shape and the causes of the intestine obstruction. CT is regarded as the best way to know whether patients need expectant treatment or close follow-up or they should receive immediate operation treatment. This paper tries to analyze the characteristics of multi-slice computed tomography diagnosis in the small bowel obstruction through the analysis of30cases of small bowel obstruction confirmed by clinical diagnosis and operation.
Methods:Collect30cases of small bowelobstruction clinical or operation confirmed from January,2011to July,2012in our hospital, among which include18males and12females. Their ages are between31to77, and the average age is52. The clinical manifestations are abdominal pain, abdominal distension, vomit, melena, and the stopping of exhaust defecation. Among these cases, there are8ones which have previous operation and1case which has previous external injury. The flight lead should be1while the slice thickness should be5mm. Because the patients of this group should have clinical fasting, gastrointestinal decompression, or they receive emergency treatment, so they didn't take contrast agent, and the small bowel contents can act as the natural contrast agent,so only5cases taked isotonic solution of manicol liquid. There are22cases which have received plain scan and8cases which receive plain and enhancement scan.
Results:
1. The existence of obstruction:the sensibility of CT is100%in these30cases. Intestinal tube has segmental or universal expansion, effusion, pneumatosis, and the expansion of small intestine diameter is over2.5cm, and22cases among these have positive transitional zone.
2. The determination of the obstruction:According to the standards of diagnosis and depending on multi-planar reconstruction, there are11high obstructions,19low obstructions. While the result of operation or clinical confirmed result is14high obstructions and16low obstructions, there are3cases of misdiagnosis, and the accuracy rate is90%.
3. The causes of obstruction:the accuracy rate of the causes of the disease is86.7%. In the30cases, there are12cases of pathologically or clinically confirmed adhesive obstruction,8neoplastic obstruction,3intussusceptions obstruction (including2ones caused by neoplastic obstruction),3intestinal twist obstruction,2cases caused by the blood supply,1case caused by internal heynia,l external injury,2tumor suppressor obstruction. There are4misdiagnosis, among which include2cases which misdiagnose adhesive obstruction as neoplastic obstruction,1internal heynia obstruction as mesentery twist,1ileocecal junction lipoma intussusceptions as intussusceptions. The obstruction caused by different reasons has different manifestation in the CT. In the adhesive obstruction, there are10cases of the sink of the proximal intestine and intestinal tube expansion of the distal intestine,2cases of angle sign,9partial adhesive band syndromes. In the obstruction caused by tumor, there are5cases in which soft tissue mass or uneven thickening of the intestinal wall can be seen in the position of obstruction. There are2cases of obstruction caused by intussusceptions which in turn is caused by tumor. There are4cases of lymphadenovarix near the mesentery or intrahepatic metastasis. In the obstruction caused by intussusceptions, the circle-like change in the enteric cavity and the entanglement of low density y mesentery can be seen. All in all, in these cases examined by the multi-slice computed tomography, the sensitivity of the examination is100%and the accuracy of determination of the position is91%, the cause of the desease is86%. The CT manifestation of small bowel obstruction is that intestinal tube has segmental or universal expansion, effusion, pneumatosis. Different reasons have different manifestations in CT.
Conclusion:the positive rate can reach100%in the diagnosis of small intestine obstruction by using multi-slice computed tomography. it has also high sensitivity in determining the causes and positions of obstruction, so multi-slice computed tomography is an very effective way. A better understanding and careful analysis of small bowel obstruction in the CT manifestation is very helpful in accurate diagnosis, and thus an immediate clinical decision can be made.
引文
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