發(fā)布時(shí)間：2018-08-19 18:40

【摘要】：目的 探討CT在缺血性結(jié)腸炎(Ischemic Colitis, IC)的診斷及分期中的價(jià)值。 資料與方法 回顧性分析31例經(jīng)腸鏡證實(shí)的缺血性結(jié)腸炎患者的CT資料,所有病例行全腹CT平掃及增強(qiáng)掃描,并經(jīng)多平面重建(MPR)及CTA后處理,分析IC急性期、非急性期病變的影像學(xué)特征,并與結(jié)腸鏡檢查比較。 結(jié)果 病變較多累及左半結(jié)腸,較少累及直腸。主要表現(xiàn)為腸壁均勻?qū)ΨQ性增厚、腸壁分層、拇紋征、腸周脂肪間隙模糊或清晰。病變腸段黏膜連續(xù),呈節(jié)段性分布,管腔狹窄,腹腔積液。31例結(jié)腸鏡檢查及病理證實(shí)的IC患者中,CT檢查發(fā)現(xiàn)IC的符合率為77.42%(24/31)；其中急性期符合率為90.90%(10/11),非急性期為70.00%(14/20)。急性期與非急性期病變CT在腸壁厚度、拇紋征、腸周脂肪間隙清晰度、腸壁分層、黏膜下強(qiáng)化程度有統(tǒng)計(jì)學(xué)差異(P0.05)。CTA顯示腸系膜上下動(dòng)脈主干存在異常陽性率為12.90%(4/31),MPR重建顯示病變腸段邊緣動(dòng)脈增多改變。 結(jié)論 螺旋CT增強(qiáng)掃描及MPR檢查對(duì)缺血性結(jié)腸炎具有較高的診斷及鑒別診斷價(jià)值,對(duì)分期有較大的幫助,能指導(dǎo)臨床早期治療從而獲取較好療效。而CTA顯示腸系膜上下動(dòng)脈主干多無栓塞,MPR重建顯示邊緣動(dòng)脈增多改變提示IC非血管栓塞所致,可以與急性腸系膜缺血(acute mesenteric ischemia, AMI)相鑒別以避免盲目溶栓治療。
[Abstract]:objective
Objective to investigate the value of CT in the diagnosis and staging of Ischemic Colitis (IC).
Data and methods
CT data of 31 patients with ischemic colitis confirmed by enteroscopy were analyzed retrospectively. All patients underwent plain and enhanced CT scan of the whole abdomen. The imaging features of acute and non-acute lesions in IC were analyzed and compared with colonoscopy.
Result
The main manifestations were symmetrical thickening of the intestinal wall, stratification of the intestinal wall, thumbprint sign, blurred or clear periintestinal fat space. The lesions were continuous and segmental mucosa with narrow lumen and peritoneal effusion. In 31 patients with IC confirmed by colonoscopy and pathology, CT showed the coincidence rate of IC. The coincidence rate was 90.90% (10/11) in the acute phase and 70.00% (14/20) in the non-acute phase. There were significant differences in the intestinal wall thickness, thumbprint sign, intestinal fat clearance, intestinal wall stratification and submucosal enhancement between the acute phase and the non-acute phase (P 0.05). 0% (4/31), MPR reconstruction showed a change in the marginal artery of the lesion.
conclusion
Enhanced spiral CT scan and MPR examination have higher diagnostic and differential diagnostic value for ischemic colitis, and are helpful for staging and guiding early clinical treatment to obtain better curative effect. It can be differentiated from acute mesenteric ischemia (AMI) to avoid blind thrombolytic therapy.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R574.62

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 莊奇新;尚克中;李文彬;程英升;顧一峰;趙培榮;趙秉輝;張惠箴;;老年性缺血性腸炎的影像診斷[J];放射學(xué)實(shí)踐;2005年11期

2 楊麗;劉鵬;楊瑜明;;缺血性腸炎臨床診斷及誤診原因分析[J];胃腸病學(xué)和肝病學(xué)雜志;2011年12期

3 沈峰;范建高;;缺血性結(jié)腸炎研究現(xiàn)狀[J];胃腸病學(xué);2010年12期

4 陳姍姍;范一宏;孟立娜;;結(jié)腸鏡相關(guān)缺血性結(jié)腸炎2例并文獻(xiàn)分析[J];胃腸病學(xué);2012年01期

5 陳小微;陶麗萍;陳壇弨;黃智銘;;非壞疽型缺血性結(jié)腸炎結(jié)腸鏡與CT表現(xiàn)比較分析[J];溫州醫(yī)學(xué)院學(xué)報(bào);2011年01期

6 程太鋼;張禹;;缺血性腸病的影象學(xué)檢查方法[J];世界華人消化雜志;2001年12期

7 趙恭華，李挺，劉霞，王穎;缺血性腸炎病理分析[J];診斷病理學(xué)雜志;1995年04期

8 楊小紅;;缺血性結(jié)腸炎的臨床分析[J];中華消化內(nèi)鏡雜志;2007年06期

9 Angeliki Theodoropoulou;Ioannis E Koutroubakis;;Ischemic colitis:Clinical practice in diagnosis and treatment[J];World Journal of Gastroenterology;2008年48期

10 Francesca Iacobellis;Daniela Berritto;Francesco Somma;Carlo Cavaliere;Marco Corona;Santolo Cozzolino;Franco Fulciniti;Salvatore Cappabianca;Antonio Rotondo;Roberto Grassi;;Magnetic resonance imaging:A new tool for diagnosis of acute ischemic colitis?[J];World Journal of Gastroenterology;2012年13期

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