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中华消化病与影像杂志(电子版) ›› 2020, Vol. 10 ›› Issue (06) : 262 -266. doi: 10.3877/cma.j.issn.2095-2015.2020.06.006

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粘连性小肠梗阻的CT影像及其临床应用研究进展
周才金1,(), 颜涛1, 张奕文2   
  1. 1. 518106 广东省,中国科学院大学深圳医院医学影像科
    2. 518106 广东省,中国科学院大学深圳医院普通外科
  • 收稿日期:2020-07-16 出版日期:2020-12-01
  • 通信作者: 周才金

Research progress of CT features and its clinical application in adhesive small bowel obstruction

Caijin Zhou1,(), Tao Yan1, Yiwen Zhang2   

  1. 1. Department of Medical Imaging, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen 518106, China
    2. Deparment of General Surgery, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen 518106, China
  • Received:2020-07-16 Published:2020-12-01
  • Corresponding author: Caijin Zhou
引用本文:

周才金, 颜涛, 张奕文. 粘连性小肠梗阻的CT影像及其临床应用研究进展[J/OL]. 中华消化病与影像杂志(电子版), 2020, 10(06): 262-266.

Caijin Zhou, Tao Yan, Yiwen Zhang. Research progress of CT features and its clinical application in adhesive small bowel obstruction[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2020, 10(06): 262-266.

粘连性小肠梗阻是肠梗阻最常见的类型,是临床上常见的急腹症之一,临床上对如何准确有效判断患者是否手术治疗以及手术的时机,仍是棘手的问题。多层螺旋CT不但能准确诊断粘连性肠梗阻,还能进一步显示粘连的方式、部位、形态及有无肠管缺血状态,为临床医师评估病情及治疗方法选择提供重要依据。

Adhesive small bowel obstruction is the leading cause of intestinal obstruction which is common in acute abdomen.It is still difficult to decide appropriately whether the patients are treated by emergency surgery or for an opportune moment to surgery.It is not only accurately diagnosed adhesive ileus, but also showed the adhesion type, obstruction location, obstruction point shape and ischemia degree in detail mode with multi-slice CT, and provides more definite information for clinicians to diagnose and make treatment plan.

图2 手术证实粘连性腹内疝并绞榨性肠梗阻患者,箭头显示半环形粘连带,形成疝环,内见肠系膜及血管积聚,星号显示为扩张肠管,肠腔内稍高密度液体充填,肠壁密度减低,提示肠管缺血坏死。
图4 为粘连垫梗阻患者,梗阻远端与后腹壁粘连,近端轴向扭转,箭头所指为轴向扭转的肠管,管腔狭窄,引起重度梗阻,近端小肠扩张积液,可见液气平面。
图5 为多发粘连垫梗阻患者,箭头所示为多发粘连垫,有肠壁与腹壁腹膜粘连,也有肠壁与肠壁粘连,近端肠管轻度扩张积液,伴液气平面,星号所示为小肠粪便征。
图6 6A、6B,分别为同一粘连垫梗阻患者的冠位及轴位图,箭头所示为致密粘连垫,星号为形成的闭环肠袢;手术证实腹壁疤痕形成粗大致密粘连垫,与相邻多个肠管壁紧密粘连,中间肠管扩张形成闭环肠袢。
1
Hwang JY, Lee JK, Lee JE,et al.Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion[J].Eur Radiol,2009,19(10):2425-2431.
2
Foster NM, MCGory ML, Zingmond DS,et al.Small bowel obstruction:a population-based appraisal[J].J Am Coll Surg,2006,203(2):170-176.
3
Jones K, Mangram AJ, Lebron RA,et al.Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction?[J].Am J Surg,2007,194(6):780-783.
4
Petrovic B, Nikolaidis P, Hammond NA,et al.Identification of adhesions on CT in small-bowel obstruction[J].Emerg Radiol,2006,12(3):88-93.
5
崔慧,高青,王光彬.粘连性小肠梗阻典型CT征象分析[J].医学影像学杂志,2019,29(12):2072-2077.
6
Ten Broek RPG, Krielen P, Di Saverio, S,et al.Bologna guidelines for diagnosis and management of adhesive small bowel obstruction(ASBO):2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group[J].World J Emerg Surg,2018,13(24):2-13.
7
Gupta R, Mittal P, Mittal,et al.Spectrum of MDCT Findings in Bowel Obstruction in a Tertiary Care Rural Hospital in Northern India[J].J Clin Diagn Res,2016,10(11):TC01-TC04.
8
Zielinski MD, Eiken PW, Heller SF et al.Prospective,observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention[J].J Am Coll Surg,2011,212(6):1068-1076.
9
王婧,强永乾.肠梗阻手术指征的多排螺旋CT征象[J/CD].中华消化病与影像杂志(电子版),2018,8(3):102-106.
10
Zhengyan Li, Ling Zhang, Xijiao Liu,et al.Diagnostic utility of CT for small bowel obstruction:Systematic review and meta analysis[J].PLoS One,2019,14(12)e0226740.
11
Osada H, Watanabe W, Ohno H.et al.Multidetector CT appearance of adhesion-induced small bowel obstructions:matted adhesions versus single adhesive bands[J].Jpn J Radiol,2012,30(9):706-711.
12
Delabrousse E, Lubrano J, Jehl J,et al.Small-Bowel Obstruction from Adhesive Bands and Matted Adhesions:CT Differentiation[J].AJR Am J Roentgenol,2009,192(3):693-697.
13
Rondenet C, Millet I, Corno L,et al.Increased unenhanced bowel-wall attenuation:a specific sign of bowel necrosis in closed-loop small-bowel obstruction[J].Eur Radiol,2018,28(10):4225-4233.
14
Gumán-Valdivia-Gómez G, Tena-Betancourt E, de Alva-Coria PM.Postoperative abdominal adhesions:pathogenesis and current preventive techniques[J].Cir Cir,2019,87(6):698-703.
15
Khaled W, Millet I, Corno L,et al.Clinical Relevance of the Feces-Sign in Small-Bowel Obstruction Due to Adhesions Depends on Its Location[J].AJR Am J Roentgenol,2018,210(1):78-84.
16
Lazarus DE, Slywotsky C, Bennett GL,et al.Frequency and relevance of the " small-bowel feces" sign on CT in patients with small-bowel obstruction[J].AJR Am J Roentgenol,2004,183(5):1361-1366.
17
Chang WC, Ko KH, Hsu HH,et al.Features on MDCT that predict surgery in patients with adhesive-related small bowel obstruction[J].PLoS One,2014,9(2):e89804.
18
Delabrousse E, Baulard R, Sarlieve P,et al.Value of the small bowel feces sign at CT in adhesive small bowel obstruction[J].J Radiol,2005,86(4):393-398.
19
Millet I, Boutot D, Faget C,et al Assessment of strangulation in adhesive small bowel obstruction on the basis of combined CT findings:implications for clinical care[J].Radiology,2017,285(3):798-808.
20
Rondenet C, Millet I, Corno L,et al.CT diagnosis of closed loop bowel obstruction mechanism is not sufficient to indicate emergent surgery[J].Eur Radiol,2020,30(2):1105-1112.
21
黄小华,张小明,董国礼,等.CT诊断实验性小肠闭袢性肠梗阻肠壁缺血程度的准确性[J].中国医学影像技术,2009,25(6):977-980.
22
Makar RA, Bashir MR, Haystead CM,et al.Diagnostic performance of MDCT in identifying closed loop small bowel obstruction[J].Abdom Radiol,2016,41(7):1253-1260.
23
Deshmukh SD, Shin DS, Willmann JK,et al.Non-emergency small bowel obstruction:assessment of CT findings that predict need for surgery[J].Eur Radio,2011,21(5):982-986.
24
Millet I, Ruyer A, Alili C,et al.Adhesive Small-Bowel Obstruction:Value of CT in Identifying Findings Associated with the Effectiveness of Nonsurgical Treatment[J].Radiology,2014,273(2):425-432.
25
郑泽霖,房学东.绞窄性肠梗阻的病理生理和临床[J].临床外科杂志,2000,3(2):71-72.
26
Bouassida M, Laamiri G, Zribi S,et al.Predicting Intestinal Ischaemia in Patients with Adhesive Small Bowel Obstruction:A Simple Score[J].World J Surg,2020,44(5):1444-1449.
27
黄朝晖,潘锦杨,朱智伟,等.螺旋CT检查在绞窄性小肠梗阻诊断中的作用[J].放射学实践,2011,26(3):333-335.
28
Navas-Campo R, Moreno-Caballero L, Ezponda Casajús A,et al.Acute mesenteric ischemia:a review of the main imaging techniques and signs[J].Radiologia,2020,5(5).
29
Mallo RD, Salem L, Lalani T,et al.Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction:A systematic review[J].J Gastroin test Surg,2005,9(5):690-694.
30
Calame P, Malakhia A, Turco C,et al.Transmural Bowel Necrosis From Acute Mesenteric Ischemia and Strangulated Small-Bowel Obstruction:Distinctive CT Features[J].AJR Am J Roentgenol,2020,214(1):90-95.
31
Strik C, Stommel MW, Ten Broek RP,et al.Adhesiolysis in patients undergoing a repeat median laparotomy[J].Dis Colon Rectum,2015,58(8):792-798.
32
Skoglar A, Gunnarsson U, Falk P.Band adhesions not related to previous abdominal surgery-A retrospective cohort analysis of risk factors[J].Ann Med Surg(Lond),2018,12(36):185-190.
33
Suh SW, Cho YS.Laparoscopy for Small Bowel Obstruction Caused by Single Adhesive Band[J].JSLS,2016,20(3):e2016.00048.
34
Catena F, Di Saverio S, Coccolini F,et al.Adhesive small bowel adhesions obstruction:Evolutions in diagnosis,management and prevention[J].World J Gastrointest Surg,2016,8(3):222-231.
35
Hajibandeh S, Hajibandeh S, Panda N,et al.Operative versus non-operative management of adhesive small bowel obstruction:A systematic review and meta-analysis[J].Int J Surg,2017,45:58-66.
36
Ten Broek RP, Strik C, Issa Y,et al.Adhesiolysis-related morbidity in abdominal surgery[J].Ann Surg,2013;258(1):98-106.
37
Chraufnagel D, Rajaee S, Millham FH.How many sunsets? Timing of surgery in adhesive small bowel obstruction:a study of the nationwide inpatient sample[J].J Trauma Acute Care Surg,2013;74(1):181-187.
38
Teixeira PG, Karamanos E, Talving P,et al.Early operation is associated with a survival benefit for patients with adhesive bowel obstruction[J].Ann Surg,2013,258(3):459-465.
39
Hackenberg T, Mentula P, Leppaniemi A,et al.Laparoscopic versus open surgery for acute adhesive small-bowel obstruction:a propensity score-matched analysis[J].Scand J Surg,2017,106(1):28-33.
40
Karamanos E, Dulchavsky S, Beale E,et al.Diabetes mellitus in patients presenting with adhesive small bowel obstruction:delaying surgical intervention results in worse outcomes[J].World J Surg,2016,40(4):863-869.
41
Lee IK, Kim DH, Gorden DL,et al.Selective laparoscopic management of adhesive small bowel obstruction using CT guidance[J].Am Surg,2009,75(3):227-231.
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