【摘要】：第一部分三種不同中性對(duì)比劑MSCTE小腸擴(kuò)張效果的對(duì)比研究目的:分析比較臨床懷疑小腸疾病患者口服三種不同中性對(duì)比劑小腸擴(kuò)張程度的差異性,為臨床口服低張小腸造影選擇合適的對(duì)比劑提供依據(jù)。方法:收集我院2014年1月至3月期間臨床懷疑小腸疾病且無(wú)明確腸梗阻患者共60例,隨機(jī)分為三組并口服三種不同的中性對(duì)比劑,即2.5%等滲甘露醇組、純牛奶組、純凈水組各20例。60例患者均行CT增強(qiáng)雙期掃描,所有數(shù)據(jù)建薄后導(dǎo)入后臺(tái)獨(dú)立工作站進(jìn)行圖像三維后重組,然后采用盲法原則經(jīng)過(guò)兩位具有豐富經(jīng)驗(yàn)的放射科醫(yī)生分析重組圖像,判斷全組小腸及各段小腸擴(kuò)張程度,最后對(duì)所測(cè)量數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:全組小腸整體擴(kuò)張程度比較:三組差異有統(tǒng)計(jì)學(xué)意義,等滲甘露醇組擴(kuò)張程度最好,與純牛奶組及純水組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05),純牛奶組與純凈水組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);組內(nèi)各段小腸比較:回腸擴(kuò)張效果最好,空腸其次,十二指腸擴(kuò)張效果稍差。結(jié)論:2.5%等滲甘露醇擴(kuò)張小腸腸管效果最好,更利于發(fā)現(xiàn)小腸病變,可推薦臨床對(duì)懷疑小腸疾病患者口服2.5%等滲甘露醇行多層螺旋CT檢查。第二部分MSCTE對(duì)小腸疾病的診斷價(jià)值研究目的:探討多層螺旋CT口服低張小腸造影(MSCTE)對(duì)小腸疾病的臨床診斷價(jià)值。方法:收集我院2014年4月至2015年2月期間消化內(nèi)科及胃腸外科臨床診斷懷疑小腸疾病并符合本研究納入條件的患者共98例,CT掃描前按要求口服2.5%等滲甘露醇溶液1000～1500ml,所有患者均行多層螺旋CT軸位連續(xù)增強(qiáng)雙期掃描,通過(guò)橫斷位、冠矢狀位重建及曲面重組、血管成像技術(shù)觀察是否有小腸病變,若有小腸病變應(yīng)進(jìn)一步觀察病變部位、大小、形態(tài)、強(qiáng)化特點(diǎn)、與周圍組織關(guān)系及遠(yuǎn)處轉(zhuǎn)移情況,最后將MSCTE診斷結(jié)果與最終臨床診斷作對(duì)照分析。結(jié)果:本研究98例患者中,53例患者M(jìn)SCTE診斷發(fā)現(xiàn)有小腸疾病,沒(méi)有發(fā)現(xiàn)小腸病變者共45例,而最終臨床診斷共58例有小腸病變,40例無(wú)小腸病變。MSCTE診斷共漏診5例,其中包括空腸腺癌1例、腹型過(guò)敏性紫癜1例、腸結(jié)石1例、小腸血管畸形2例,誤診2例,包括空腸腺癌誤診為淋巴瘤1例、腹型過(guò)敏性紫癜誤診為腸結(jié)核1例。本研究中MSCTE診斷小腸疾病的靈敏度為91.38%(53/58),特異度為100%(40/40),陽(yáng)性預(yù)測(cè)值為100%(53/53),陰性預(yù)測(cè)值為88.89%(40/45),診斷正確率為92.86%((51+40)/98)。58例小腸病變中,腫瘤性病變共26例,其中腺癌13例,發(fā)生于十二指腸3例,2例表現(xiàn)為十二指腸降段及水平段起始部管壁環(huán)形增厚,增強(qiáng)輕中度強(qiáng)化,腸腔輕度狹窄,1例表現(xiàn)為十二指腸降段突向腔內(nèi)的軟組織結(jié)節(jié)影,增強(qiáng)明顯均勻強(qiáng)化,3例均未引起近段腸梗阻征象;發(fā)生于空腸5例,位于空腸近端2例,1例表現(xiàn)為腔內(nèi)類圓形軟組織腫塊影,增強(qiáng)明顯均勻強(qiáng)化,1例表現(xiàn)為腸壁明顯增厚伴異常強(qiáng)化,2例均引起十二指腸梗阻擴(kuò)張,位于空腸中遠(yuǎn)段2例,1例為絨毛狀腺瘤惡變?yōu)檎骋合侔?表現(xiàn)為空腸遠(yuǎn)段腔內(nèi)較大分葉狀腫塊影,同時(shí)可見(jiàn)近段腸管內(nèi)膠囊內(nèi)鏡滯留,1例表現(xiàn)為空腸壁不規(guī)則增厚伴腸腔擴(kuò)張,MSCTE誤診為小腸淋巴瘤,1例MSCTE漏診;發(fā)生于回腸(包括回盲部)共5例,2例表現(xiàn)為回腸壁局限性環(huán)形增厚,3例為回盲部腫塊影,其中1例侵犯升結(jié)腸并引起低位小腸梗阻。小腸淋巴瘤4例,均表現(xiàn)為較長(zhǎng)范圍的腸壁環(huán)形增厚、腸腔不狹窄,2例可見(jiàn)腹腔腹膜后多發(fā)淋巴結(jié)增大。小腸間質(zhì)瘤6例,其中3例表現(xiàn)為腔內(nèi)均勻明顯強(qiáng)化的軟組織腫塊影(最大徑5cm),邊界較清晰,動(dòng)脈期病灶內(nèi)可見(jiàn)多發(fā)血管影,3例表現(xiàn)為較大囊實(shí)性腫塊影,其內(nèi)見(jiàn)較多液化壞死及氣體影。小腸脂肪瘤3例,均表現(xiàn)為小腸內(nèi)多發(fā)結(jié)節(jié)狀脂肪密度影。小腸炎癥性病變共24例,其中克羅恩病4例,均表現(xiàn)為空回腸多節(jié)段性腸壁增厚伴腸壁強(qiáng)化,一例伴有腹腔膿腫形成并侵犯右腹直肌,一例伴有腸系膜多發(fā)小膿腫及肛周膿腫形成;潰瘍性結(jié)腸炎3例,2例表現(xiàn)為降結(jié)腸、乙狀結(jié)腸及直腸黏膜異常強(qiáng)化,肌層水腫,漿膜層模糊不清,1例表現(xiàn)為全結(jié)腸連續(xù)性腸壁增厚并異常強(qiáng)化,腸系膜增厚且明顯強(qiáng)化;腸結(jié)核7例,3例表現(xiàn)為廣泛腹膜、系膜增厚呈"腹繭癥",小腸被聚集且腸壁彌漫性增厚,腹腔多發(fā)淋巴結(jié)增大,環(huán)形強(qiáng)化,4例表現(xiàn)為回腸末端、回盲部腸壁增厚、異常強(qiáng)化,腹腔積液,腹膜增厚;腹型過(guò)敏性紫癜5例,3例表現(xiàn)為小腸節(jié)段性腸粘膜增粗、明顯強(qiáng)化,腸腔未見(jiàn)狹窄,其中1例合并盆腔積液,1例表現(xiàn)為回盲部及回腸末端腸壁增厚,腹腔腹膜后多發(fā)淋巴結(jié)增大,腹膜增厚,MSCTE誤診為腸結(jié)核,1例MSCTE漏診。一般炎癥性疾病5例。腸結(jié)石1例,MSCTE漏診。腸系膜血管病變7例,包括腸系膜扭轉(zhuǎn)2例,均不伴有腸壁缺血壞死,腸系膜上靜脈及門靜脈血栓2例,較長(zhǎng)范圍小腸壁缺血壞死,腸系膜上動(dòng)脈栓塞1例,節(jié)段性小腸壁水腫增厚,小腸血管畸形2例,MSCTE漏診。結(jié)論:小腸腫瘤性病變、炎癥性病變及血管性病變等在MSCTE上具有相對(duì)特征性的表現(xiàn),MSCTE能全面展示小腸腔內(nèi)外病變、腸系膜、系膜血管及其他臟器情況,對(duì)小腸疾病的診斷具有重要價(jià)值。
[Abstract]:Objective: To compare the effects of three different neutral contrast agents (MSCTE) on small intestinal dilatation in patients with suspected small intestinal diseases, and to provide evidence for the selection of suitable contrast agents for oral hypotonic enterography. Sixty patients with suspected small intestinal disease and no definite intestinal obstruction were randomly divided into three groups and treated with three different neutral contrast agents, namely, 2.5% isotonic mannitol group, pure milk group and pure water group, 20 patients in each group. Then the reconstructed images were analyzed by two experienced radiologists to judge the degree of dilatation of the whole small intestine and each segment of the small intestine. There was no significant difference between pure milk group and pure water group (P 0.05). Compared with pure water group, ileal dilatation was the best, jejunum was the second, and duodenal dilatation was slightly worse. Multislice spiral CT examination of 2.5% isotonic mannitol is recommended for patients suspected of small intestinal diseases. Part 2: The diagnostic value of MSCTE in small intestinal diseases. Objective: To investigate the clinical diagnostic value of MSCTE in small intestinal diseases. A total of 98 patients with suspected small intestinal diseases and eligible for inclusion in this study were diagnosed by gastrointestinal surgery and gastrointestinal surgery. Before CT scan, 2.5% isotonic mannitol solution was taken orally for 1000-1500 ml. All patients underwent axial continuous enhanced dual-phase multi-slice spiral CT scanning. Through transection, coronary-sagittal reconstruction and curved surface reconstruction, vascular imaging techniques were performed. If there are small intestinal lesions, we should further observe the location, size, shape, enhancement characteristics, relationship with surrounding tissues and distant metastasis. Finally, the MSCTE diagnosis results were compared with the final clinical diagnosis. Results: Among the 98 patients in this study, 53 patients were diagnosed with small intestinal diseases by MSCTE, without any occurrence. There were 45 cases of small intestinal lesions and 58 cases of small intestinal lesions and 40 cases of non-small intestinal lesions. 5 cases were missed by MSCTE, including 1 case of jejunal adenocarcinoma, 1 case of abdominal allergic purpura, 1 case of enterolithiasis, 2 cases of small intestinal vascular malformation, 2 cases of misdiagnosis, including 1 case of jejunal adenocarcinoma misdiagnosed as lymphoma, 1 case of abdominal allergic Pura misdiagnosed as intestinal nodules. The sensitivity, specificity, positive predictive value and negative predictive value of MSCTE were 91.38% (53/58), 100% (40/40), 100% (53/53), 88.89% (40/45) and 92.86% ((51+40)/98). Among 58 cases of small intestinal lesions, 26 were malignant, including 13 adenocarcinoma, 3 duodenum and 2 duodenum. The wall of the descending and horizontal segments of the duodenum was thickened circularly, slightly and moderately enhanced, and the intestinal cavity was narrowed slightly. One case showed soft tissue nodules protruding from the descending segment of the duodenum. The enhancement was uniformly enhanced. No proximal intestinal obstruction was found in 3 cases. Soft tissue mass showed marked homogeneous enhancement. One case showed marked thickening of intestinal wall with abnormal enhancement. Two cases had duodenal obstruction and dilatation. Two cases were located in the middle and distal part of the jejunum. One case was malignant transformation of villous adenoma into mucinous adenocarcinoma. Large lobular mass was seen in the distal part of the jejunum. There were 5 cases of irregular thickening of jejunal wall with dilatation of intestinal cavity, 1 case of misdiagnosis of small intestinal lymphoma by MSCTE, 1 case of missed diagnosis by MSCTE, 2 cases of localized circular thickening of ileocecal wall, 3 cases of ileocecal mass, and 1 case of ascending colon with low intestinal obstruction. There were 6 cases of small intestinal stromal tumors, 3 of which showed homogeneous and markedly enhanced soft tissue mass (maximum diameter 5 cm), clear boundary, multiple vascular shadow in arterial phase, 3 of which showed large cystic and solid mass, and more in them. Liquefied necrosis and gas shadow. 3 cases of small intestinal lipoma showed multiple nodular fat density shadows in the small intestine. 24 cases of small intestinal inflammatory lesions, including 4 cases of Crohn's disease, were manifested as multiple segmental thickening of jejuno-ileal intestinal wall with intestinal wall enhancement, one case with abdominal abscess formation and invasion of right rectus abdominis, one case with multiple mesenteric abscesses. 3 cases of ulcerative colitis, 2 cases of descending colon, abnormal enhancement of sigmoid and rectal mucosa, myoedema, vague serosa, 1 case of total colon continuous intestinal wall thickening and abnormal enhancement, mesentery thickening and obvious enhancement; 7 cases of intestinal tuberculosis, 3 cases of extensive peritoneum, mesenteric thickening was "abdominal cocoon disease" The small intestine was gathered and diffuse thickening of the intestinal wall, multiple lymph node enlargement and circular enhancement of the abdominal cavity. 4 cases showed thickening and abnormal enhancement of the ileocecal intestinal wall at the end of the ileum, peritoneal effusion, peritoneal thickening; 5 cases of abdominal allergic purpura, 3 cases showed segmental thickening of the intestinal mucosa, obvious enhancement, and no stricture of the intestine, including 1 case with pelvic effusion. One case was misdiagnosed as intestinal tuberculosis by MSCTE, and the other was misdiagnosed as intestinal tuberculosis by MSCTE. There were 5 cases of general inflammatory diseases, 1 case of intestinal calculi, 1 case of MSCTE misdiagnosis. There were 2 cases of portal vein thrombosis, 1 case of ischemic necrosis of small intestinal wall, 1 case of superior mesenteric artery embolism, 2 cases of segmental small intestinal wall edema, 2 cases of small intestinal vascular malformation, and MSCTE missed diagnosis. Mesentery, mesangial vessels and other organs are of great value in the diagnosis of small bowel diseases.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R816.5;R574

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊麗;;老年人小腸造影術(shù)后預(yù)防鋇石形成的護(hù)理體會(huì)[J];中國(guó)實(shí)用護(hù)理雜志;1989年09期

2 陳有存;李素英;劉志永;;胃復(fù)安用于小腸造影60例[J];醫(yī)學(xué)理論與實(shí)踐;1992年05期

3 張聯(lián)合,章士正;多排螺旋計(jì)算機(jī)斷層成像技術(shù)小腸造影[J];中華消化雜志;2005年04期

4 李洪松,王玉國(guó),武玉坤,王霞;數(shù)字胃腸下多相位低張小腸造影的臨床應(yīng)用[J];醫(yī)學(xué)理論與實(shí)踐;2005年01期

5 李德春;李瑞紅;;X線下經(jīng)鼻-空腸置管小腸造影的臨床應(yīng)用[J];放射學(xué)實(shí)踐;2006年03期

6 田躍,席光煥,李風(fēng)雛,陳重,張鐵梁;小腸雙重對(duì)比灌腸造影(國(guó)產(chǎn)小腸造影導(dǎo)管50例臨床應(yīng)用)[J];實(shí)用放射學(xué)雜志;1986年04期

7 劉洪;動(dòng)力性小腸造影的初步探討[J];實(shí)用放射學(xué)雜志;1989年01期

8 余建國(guó),姚安晉;用于小腸造影的兩種鋇混懸液的比較[J];現(xiàn)代醫(yī)用影像學(xué);2000年01期

9 白雹,黃超;鋇餐小腸造影相關(guān)性聚團(tuán)菌菌血癥1例[J];中華醫(yī)院感染學(xué)雜志;2000年02期

10 耿麗莉;李海波;孫劃;王宏光;;多層螺旋CT小腸造影在小腸疾病中的應(yīng)用[J];中國(guó)臨床醫(yī)學(xué)影像雜志;2007年05期

相關(guān)會(huì)議論文 前6條

1 熊斌;;遠(yuǎn)端胃部分切除患者的小腸造影研究[A];中華醫(yī)學(xué)會(huì)第十三屆全國(guó)放射學(xué)大會(huì)論文匯編（下冊(cè)）[C];2006年

2 張建國(guó);楊軍;牛廣明;;無(wú)管法快速小腸氣鋇雙對(duì)比造影法的研究[A];中華醫(yī)學(xué)會(huì)第十三屆全國(guó)放射學(xué)大會(huì)論文匯編（下冊(cè)）[C];2006年

3 賴燦;;兒童MR小腸造影的臨床應(yīng)用[A];中華醫(yī)學(xué)會(huì)第16次全國(guó)放射學(xué)學(xué)術(shù)大會(huì)論文匯編[C];2009年

4 畢純龍;孫建男;楊立國(guó);劉東紅;;口服2.5%等滲甘露醇液64排螺旋CT小腸造影的臨床應(yīng)用價(jià)值[A];2010中華醫(yī)學(xué)會(huì)影像技術(shù)分會(huì)第十八次全國(guó)學(xué)術(shù)大會(huì)論文集[C];2010年

5 高劍波;郭華;耿尚文;;口服2.5%等滲甘露醇多層螺旋CT小腸造影的臨床應(yīng)用[A];2010中華醫(yī)學(xué)會(huì)影像技術(shù)分會(huì)第十八次全國(guó)學(xué)術(shù)大會(huì)論文集[C];2010年

6 高旭寧;許茂盛;盧良驥;丁國(guó)苗;王世威;;CT小腸造影對(duì)活動(dòng)性克羅恩病的診斷價(jià)值[A];第十一次全國(guó)中西醫(yī)結(jié)合影像學(xué)術(shù)研討會(huì)暨全國(guó)中西醫(yī)結(jié)合影像學(xué)研究進(jìn)展學(xué)習(xí)班資料匯編[C];2010年

相關(guān)博士學(xué)位論文 前1條

1 張聯(lián)合;口服法多排螺旋CT小腸造影[D];浙江大學(xué);2005年

相關(guān)碩士學(xué)位論文 前10條

1 蔡詩(shī)墁;多層螺旋CT小腸造影的臨床應(yīng)用研究[D];川北醫(yī)學(xué)院;2016年

2 李操;多層螺旋CT口服低張小腸造影的臨床應(yīng)用研究[D];西南醫(yī)科大學(xué);2015年

3 劉小艷;插管法0.9%生理鹽水多層螺旋CT小腸造影的臨床應(yīng)用價(jià)值[D];昆明醫(yī)科大學(xué);2012年

4 王界斌;口服甘露醇鹽水多排螺旋CT小腸造影的應(yīng)用價(jià)值[D];南昌大學(xué);2010年

5 毛志群;多層螺旋CT口服小腸造影（MSCTE）的臨床應(yīng)用[D];南昌大學(xué);2008年

6 朱希松;評(píng)價(jià)多排螺旋CT小腸造影對(duì)Crohn病的診斷價(jià)值[D];浙江大學(xué);2010年

7 燕桂新;口服高滲甘露醇鹽水多層螺旋CT小腸造影的臨床應(yīng)用價(jià)值[D];新疆醫(yī)科大學(xué);2008年

8 方舒;CT小腸造影對(duì)炎癥性腸病的診斷及對(duì)克羅恩病活動(dòng)度評(píng)估的應(yīng)用研究[D];蘇州大學(xué);2015年

9 鄧燕勇;磁共振小腸造影對(duì)Crohn病的診斷價(jià)值[D];浙江大學(xué);2004年

10 岳滔;腸道炎癥性病變口服法小腸造影多排螺旋CT表現(xiàn)研究[D];山西醫(yī)科大學(xué);2014年

，

本文編號(hào)：2187133