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目的探讨小肠梗阻伴缺血的多排螺旋CT特异性征象。方法 39例小肠梗阻患者,其中伴缺血者21例为缺血组,不伴缺血者18例为非缺血组,2组均于术前行CT平扫及增强扫描,比较2组平扫肠壁密度增高、增强肠壁密度减低、肠壁增厚、靶征、闭袢形成、漩涡征、肠壁积气、门静脉或肠系膜静脉积气、肠系膜脂肪密度增高、鸟嘴征、腹腔积液、小肠粪征出现率,logistic回归模型分析小肠梗阻患者出现缺血的特异征象。结果 2组均未出现肠壁积气、门静脉或肠系膜静脉积气征象,余10个征象中缺血组平扫肠壁密度增高(28.6%)、增强扫描肠壁密度减低(61.9%)、肠壁增厚(57.1%)、肠系膜脂肪密度增高(90.5%)、鸟嘴征(100%)出现率高于非缺血组(0、11.1%、22.2%、44.4%、66.7%)(P<0.05),2组靶征、闭袢形成、漩涡征、腹腔积液、小肠粪征出现率比较差异无统计学意义(P>0.05);多因素logistic回归分析结果显示,增强扫描肠壁密度减低(OR=7.934,95%CI:1.300~48.434,P=0.025)、肠系膜脂肪密度增高(OR=6.666,95%CI:1.045~42.534,P=0.045)与小肠梗阻患者出现缺血有关。结论多排螺旋CT增强扫描显示肠壁密度减低、肠系膜脂肪密度增高是小肠梗阻患者伴缺血的2个特异性征象。
Objective To investigate the multi-slice spiral CT-specific signs of small bowel obstruction with ischemia. Methods Totally 39 patients with intestinal obstruction, including 21 ischemic subjects with ischemic stroke and 18 ischemic subjects without ischemic stroke were enrolled in this study. Both groups underwent CT scan and contrast-enhanced scan before operation. Intestine wall increased density, increased bowel wall density decreased, thickening of the bowel wall, target signs, closed loop formation, swirl sign, intestinal wall gas, portal vein or mesenteric vein parenchyma, mesenteric fat density, beak sign, Fluid, small intestine faecal incidence, logistic regression analysis of small bowel obstruction patients with specific signs of ischemia. Results There were no signs of gas accumulation in the intestine wall, portal vein or mesenteric vein in both groups. The density of the intestine in the ischemic group increased by 28.6% in the remaining 10 cases (61.9%), The incidence of wall thickening (57.1%), mesenteric fat density (90.5%) and beak sign (100%) were higher than those in non-ischemic group (0,11.1%, 22.2%, 44.4%, 66.7% 0.05). There was no significant difference in the occurrence rate of target sign, closed loop, swirl sign, ascitic fluid and small intestine between the two groups (P> 0.05). The multivariate logistic regression analysis showed that the density of intestinal wall increased (OR = 7.934, 95% CI: 1.300-48.434, P = 0.025). The increased density of mesenteric fat (OR = 6.666,95% CI: 1.045-42.534, P = 0.045) was associated with ischemia in patients with small bowel obstruction. Conclusion Multi-slice spiral CT enhanced scan showed that the density of intestinal wall decreased, and the increased density of mesenteric fat was the two specific signs of ischemia in patients with small bowel obstruction.