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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]. 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]. 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。
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