發(fā)布時(shí)間：2019-04-19 17:33

【摘要】：目的：評(píng)價(jià)插管法灌注0.9%生理鹽水多層螺旋CT小腸造影(multislice CT enterography, MSCTE)的可行性,并探討插管法CT小腸造影在腸道疾病中的臨床應(yīng)用價(jià)值。 方法：對(duì)2009年12月～2012年4月本院就診病例29懷疑小腸疾病患者收入本組研究。插管法灌注0.9%的生理鹽水溶液1500-2000ml,于掃描前30分鐘內(nèi)持續(xù)勻速全部灌完,一般為1500ml,個(gè)別根據(jù)患者的耐受性及患者體重情況適當(dāng)增加500ml,以達(dá)到小腸各段充分?jǐn)U張,在灌注造影劑20分鐘時(shí)(即掃描前10分鐘)肌注低張藥物654-210mg,在生理鹽水灌注完后即刻行全腹部CT平掃及增強(qiáng)掃描。對(duì)29例患者的小腸擴(kuò)張程度數(shù)據(jù)分別進(jìn)行統(tǒng)計(jì)。 結(jié)果：(1).插管法多層螺旋CT小腸造影在29例患者中均成功完成了SCTE檢查,除稍感腹脹外,均無(wú)明顯不適感。(2).插管法0.9%生理鹽水多層螺旋CT小腸造影能適度地?cái)U(kuò)張腸腔,29例患者中小腸平均充盈度評(píng)分為2.82分,空腸平均充盈度評(píng)分為2.5分,回腸的平均充盈度評(píng)分為2.75分。23例擴(kuò)張度達(dá)3級(jí),4例擴(kuò)張度為2級(jí),2例擴(kuò)張度為1級(jí)�？漳c擴(kuò)張度平均為20.5±3.6mm,回腸擴(kuò)張度平均為19.0±3.2mm,空、回腸腸管擴(kuò)張度比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(3).插管法多層螺旋CT小腸造影診斷小腸腫瘤5例,活動(dòng)性Crohn’s病7例,腸結(jié)核2例,其它疾病1例,14例無(wú)異常發(fā)現(xiàn)(其中2例為假陰性)。(4).插管法多層螺旋CT小腸造影診斷腸道疾病的敏感性、特異性、準(zhǔn)確性、陽(yáng)性預(yù)測(cè)值及陰性預(yù)測(cè)值各自為88.2%,100%,93.1%,100%,85.7%。 結(jié)論：(1).0.9%生理鹽水其滲透壓值和正常人的血漿、組織液大致一樣,比較合乎生理情況,作為小腸CT陰性造影劑,能夠很好的擴(kuò)張小腸,且能很好的顯示腸壁情況,可以作為有病變小腸的一種合理造影劑的選擇,而不會(huì)加重病人的病情。(2).插管法多層螺旋CT小腸造影能很好的擴(kuò)張小腸腸管,易于發(fā)現(xiàn)和顯示腸道病變,具有較高的敏感性、特異性及準(zhǔn)確性。
[Abstract]:Aim: to evaluate the feasibility of instillation of 0.9% saline multi-slice spiral CT enterography (multislice CT enterography, MSCTE) by catheterization and to evaluate the clinical application value of CT enterography in intestinal diseases. Methods: from December 2009 to April 2012, 29 patients with suspected small bowel disease were enrolled in this study. The 0.9% saline solution was infused with 0.9% saline solution with a continuous and uniform rate of 1500ml, usually 1500ml, within 30 minutes before the scan. According to the patient's tolerance and the patient's body weight, an appropriate increase of 500ml was achieved individually in order to achieve the full dilation of the small intestine segments in order to achieve the full expansion of each segment of the small intestine. The hypotension drug 654mg / 210mg was injected intramuscularly at 20 minutes after perfusion of contrast agent (i.e. 10 minutes before scanning). The whole abdomen CT plain scan and contrast enhanced scan were performed immediately after the perfusion of normal saline. The data of the degree of intestinal dilatation in 29 patients were statistically analyzed. Results: (1). Multi-slice spiral CT enterography was successfully performed in 29 patients with abdominal distension except for slight abdominal distension. (2). 0.9% 0.9% saline multi-slice spiral CT enterography can appropriately dilate the intestinal cavity. The average intestinal filling score of 29 patients was 2.82 points, and the average filling degree of jejunum was 2.5points. The average filling score of ileum was 2.75. 23 cases were expanded to 3 grade, 4 cases to 2 grade, and 2 cases to 1 grade. The average dilation degree of jejunum and ileum were 20.5 鹵3.6mm and 19.0 鹵3.2mm, respectively. There was no significant difference between empty and ileal dilation (P0.05). (- 3). There were 5 cases of small intestinal tumors, 7 cases of active Crohn's 's disease, 2 cases of intestinal tuberculosis, 1 case of other diseases and 14 cases without abnormal findings (2 of which were false negative). (4) by multi-slice spiral CT enterography. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 88.2%, 100%, 93.1%, 100%, 85.7%, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 88.2%, 100%, 93.1%, 100%, 85.7%, respectively. Conclusion: (1) 0.9% saline has the same osmotic pressure as the normal human plasma and tissue fluid, which is in accordance with physiological conditions. As a negative contrast agent of CT in small intestine, it can dilate the small intestine very well. It can be used as a reasonable contrast medium for the diseased small intestine without aggravating the patient's condition. (2). Multi-slice spiral CT enterography with catheterization can dilate the intestinal tract easily find and display intestinal lesions and have high sensitivity specificity and accuracy.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R816.5

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