【摘要】 目的 评价多层螺旋CT中游离气体的分布对于鉴别上下消化道穿孔的价值。方法 回顾性分析76例经手术证实的消化道穿孔患者的腹部CT,包括上消化道穿孔49例,下消化道穿孔27例。比较2组患者中游离气体的不同分布有无统计学差异。结果 上下消化道穿孔在肝门、镰状韧带、圆韧带周围游离气体、胃肠道周围局限性小气泡、腹腔内肠系膜区、盆腔等方面二者均具有统计学意义(P<0.05)。肝门周围、镰状韧带周围及圆韧带周围游离气体、上消化道周围局限性小气泡影常提示上消化道穿孔。四者诊断的灵敏度及特异度分别为85.7%、91.8%、77.6%、59.2%;93.9%、87.8%、89.8%、98.0%。下消化道肠壁周围局限性小气泡、腹腔内肠系膜区及盆腔内游离气体在诊断下消化道穿孔的灵敏度及特异度分别为44.4%、55.6%、11.1%;100%、95.9%、100%。结论 CT图像上游离气体的分布有助于上下消化道穿孔的鉴别,综合游离气体的不同分布能提高穿孔部位诊断的正确率。更多还原

【Abstract】 Objective To evaluate the usefulness of distribution of free air by multi-slice spiral CT computed tomography(MSCT) to distinguish upper from lower gastrointestinal(GI) tract perforation.Methods MSCT findings of 76 patients with surgically proven GI tract perforation were analyzed retrospectively.The patients were divided into two groups:upper and lower GI tract perforation groups.The distribution of free air in the two groups were compared.Results Free air around the periportal area,falciform ligament,and ligamentum teres,concentrated extraluminal air bubbles,in the mesenteric folds of abdomen and pelvic cavity showed significant difference between two groups(P<0.05).Free air around the periportal area,falciform ligament,ligamentum teres and concentrated extraluminal air bubbles of upper GI tract indicated that the perforations were located at upper GI,in which the sensitivity and specificity were 85.7%,91.8%,77.6%,59.2% and 93.9%,87.8%,89.8%,98.0% respectively.In contrasted,free air in the mesenteric folds of abdomen,pelvic cavity and concentrated extraluminal air bubbles of lower GI tract indicated the perforation were located at lower GI,in which the sensitivity and specificity were 44.4%,55.6%,11.1% and 100%,95.9%,100%respectively.Conclusion Distribution of free air detected by CT is useful to distinguish upper from lower GI tract perforation.Combination of these different distribution of free air can improve the diagnosis accuracy of GI tract perforation.更多还原