本文選題：閉袢性腸梗阻　切入點(diǎn)：磁共振成像　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過(guò)對(duì)不同梗阻時(shí)間點(diǎn)的閉袢性腸梗阻兔模型進(jìn)行磁共振多b值DWI檢查,分析DWI成像參數(shù)(ADC值)與病理評(píng)分之間的關(guān)系,探討多b值DWI對(duì)兔閉袢性腸梗阻的診斷價(jià)值。方法:成年健康中國(guó)大耳白兔35只,雌雄不限,兔齡3-4月,體重(2.4±0.5)kg。將其進(jìn)行隨機(jī)分組,其中20只作為實(shí)驗(yàn)組(分為1h、2h、3h、4h、5h五個(gè)時(shí)間點(diǎn),每個(gè)時(shí)間點(diǎn)4只),對(duì)照組15只(與實(shí)驗(yàn)組對(duì)應(yīng)時(shí)間點(diǎn),每時(shí)間點(diǎn)3只)。實(shí)驗(yàn)組兔采用“U”形結(jié)扎制作CLO模型;對(duì)照組僅打開腹腔,暴露并翻動(dòng)腸管,而不損傷腸管。在造模后第1h、2h、3h、4h、5h行常規(guī)MRI、DWI(b=0、200、400、600、800、1000s/mm2)掃描及病理檢查。統(tǒng)計(jì)分析腸壁ADC值與病理積分及腸壁厚度間相關(guān)關(guān)系。結(jié)果:1.病理結(jié)果:對(duì)照組腸壁呈自然肉粉色,腸蠕動(dòng)明顯,腸管未見擴(kuò)張,腸系膜動(dòng)脈搏動(dòng)較明顯。腸壁組織病理學(xué)未見異常,組織結(jié)構(gòu)清晰完整。實(shí)驗(yàn)1h組梗阻腸管顏色明顯加深,部分腸管稍擴(kuò)張,腸蠕動(dòng)較正常腸管減弱,實(shí)驗(yàn)3h組梗阻腸管呈深褐色,管腔明顯擴(kuò)張,腹腔可見較多血性積液,腸蠕動(dòng)不明顯,可聞及少許腥臭味。實(shí)驗(yàn)5h組開腹即聞及腥臭味,腸管顏色呈紫褐色,管腔進(jìn)一步擴(kuò)張、積液,臨近正常腸管稍擴(kuò)張,顏色稍加深。實(shí)驗(yàn)組主要鏡下表現(xiàn)為梗阻腸組織絨毛壞死、脫落,黏膜下層組織疏松、水腫、出血,肌纖維結(jié)構(gòu)松散,排列不規(guī)整,炎癥細(xì)胞侵潤(rùn),并且隨著時(shí)間延長(zhǎng)而逐漸加重。實(shí)驗(yàn)組病理評(píng)分與對(duì)照組有顯著差異(P=0.000);實(shí)驗(yàn)組1h與2h,4h與5h腸壁的評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P值分別為0.107和0.318),而梗阻時(shí)間相差2h及以上者,腸壁的病理評(píng)分差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。2.DWI參數(shù)測(cè)量結(jié)果:實(shí)驗(yàn)組及對(duì)照組腸壁ADC值均隨b值的增加而逐漸減小。對(duì)照組各b值下不同時(shí)間點(diǎn)腸壁ADC值無(wú)差異(P0.05)。實(shí)驗(yàn)組各b值下不同時(shí)間點(diǎn)腸壁ADC值差異存在統(tǒng)計(jì)學(xué)意義(P=0.000),其中在腸梗阻2h組b=600s/mm2和b=800s/mm2時(shí)及腸梗阻4h組b=200s/mm2和b=400s/mm2時(shí)腸壁ADC值差異無(wú)統(tǒng)計(jì)學(xué)意義(P值分別為0.267和0.344),余各時(shí)間點(diǎn)組不同b值間腸壁ADC值均存在差異(P=0.000)。實(shí)驗(yàn)組不同b值下,隨時(shí)間延長(zhǎng),腸壁ADC值均逐漸減小,差異具有統(tǒng)計(jì)學(xué)意義(P=0.000)。r ADC值隨著時(shí)間的延長(zhǎng)而增加。實(shí)驗(yàn)組b=800s/mm2時(shí)腸壁ADC值與腸壁厚度中度負(fù)相關(guān)(|r|=0.449,P=0.047)。實(shí)驗(yàn)組不同b值下各組腸壁ADC值與病理積分呈負(fù)相關(guān),且具有良好的相關(guān)性(|r|0.8,P=0.000),其中b=800s/mm2時(shí)ADC值與病理積分的相關(guān)性最好(|r|=0.893)。結(jié)論:1.閉袢性腸梗阻的ADC值與病理積分具有良好的相關(guān)性,其中b=800s/mm2時(shí)相關(guān)性最好。2.當(dāng)ADC值變化率(r ADC)大于20.86%提示腸壁發(fā)生透壁性壞死。3.多b值DWI對(duì)兔閉袢性腸梗阻能夠提供有用的診斷信息。
[Abstract]:Objective: to analyze the relationship between DWI imaging parameters and pathological score by using multi-b value DWI of magnetic resonance imaging (MRM) in rabbit models of closed loop intestinal obstruction at different obstructive time points. To investigate the diagnostic value of multi-b DWI in the diagnosis of closed loop intestinal obstruction in rabbits. Methods: 35 adult healthy Chinese large ear white rabbits, male and female, aged 3-4 months, weight of 2.4 鹵0.5 kg, were randomly divided into two groups, 20 of them were divided into experimental group (1 h, 2 h, 3 h, 3 h, 4 h, 5 h, 5 h). There were 4 rats in each time point and 15 rats in the control group (3 rats in each time point corresponding to the experimental group). In the experimental group, the CLO model was made by "U" ligation, while in the control group, the abdominal cavity was opened, and the intestinal tube was exposed and turned over. No injury of intestinal duct was observed. Routine MRII / DWI / DWI / DWI / DWIBX / 200 / 200 / 600 / 800 / 1000 sm2 / m2) scan and pathological examination were performed at the first hour after modeling. The correlation between ADC value of intestinal wall and pathological score and thickness of intestinal wall was analyzed statistically. Results: 1. Pathological results: the intestinal wall of the control group was naturally pink with peristalsis, and the intestinal movement was obvious, and the results showed that the intestinal wall of the control group was pink in nature with obvious peristalsis, and the intestinal wall had obvious peristalsis. Mesenteric artery pulsation was not seen. The intestinal wall was not abnormal in histopathology, and the tissue structure was clear and complete. The color of intestinal obstruction was obviously deepened, some intestinal tubes were slightly dilated, and intestinal peristalsis was weaker in the experimental group than in the normal intestinal canal. In the experimental group, the intestinal obstruction was dark brown, the lumen was obviously dilated, more bloody effusion was found in the abdominal cavity, the intestinal peristalsis was not obvious, and a little smell of fishy odor could be smelled. In the experiment group of 5 h, the abdominal obstruction was smell and smell, the color of the intestinal tube was purple-brown, and the lumen was further dilated. The main findings of the experimental group were intestinal villus necrosis, shedding, loose submucosal tissue, edema, hemorrhage, loose structure of muscle fiber, irregular arrangement. Inflammatory cells infiltrate, The pathological score of the experimental group was significantly different from that of the control group (P = 0.000), and the score of the intestinal wall of the experimental group was not significantly different from that of the control group (P = 0.107 and 0.318g, respectively), but the difference of the obstruction time was 2 h or more than that of the control group. The difference of pathological score of intestinal wall was statistically significant. 2. The results of parameter measurement on DWI showed that the ADC value of intestinal wall in experimental group and control group decreased gradually with the increase of b value, but there was no difference in ADC value of intestinal wall in control group at different time points under b value. The experiment showed that there was no difference in ADC value of intestinal wall at different time points in control group. There was significant difference in ADC value of intestinal wall between groups at different time points under b value. There was no significant difference in ADC value of intestinal wall between 2 h group and 4 h group (P < 0. 267 and 0. 34 4), respectively, when bnr 600 s / mm2 and bN 800 s / mm2, and 4 h group with intestinal obstruction, bn 200 s / mm2 and 4 h group respectively (P = 0. 267 and 0. 344 / mm2, P < 0.05). There were differences in ADC values of intestinal wall between different b values of point group and different b values in experimental group. Over time, the ADC values of intestinal wall decreased gradually. The difference was statistically significant (P < 0.01). The value of ADC increased with time. The ADC value of intestinal wall in the experimental group was negatively correlated with the thickness of the intestinal wall at 800 s / mm ~ 2 (r = 0.449). The ADC value of the intestinal wall in the experimental group was negatively correlated with the pathological score under different b values. The correlation between ADC value and pathological score was the best (r 0.800 s / mm2) (r = 0.8930.Conclusion: 1. The ADC value of closed loop intestinal obstruction has a good correlation with pathological score, and there is a good correlation between ADC value and pathological score in BX 800s / mm2, r = 0.8930.Conclusion: 1) there is a good correlation between ADC value and pathological score in closed loop intestinal obstruction. The best correlation was at 800 s / mm2. When the change rate of ADC value was greater than 20.86%, it suggested that transmural necrosis occurred in the intestinal wall. Multi-b DWI could provide useful diagnostic information for closed loop intestinal obstruction in rabbits.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R574.2

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