【摘要】 目的分析总结小肠克罗恩病肠道及肠周病变的超声图像特征。方法回顾性选取2009年6月至2019年6月南京医科大学附属苏州医院收治的临床已确诊小肠克罗恩病的患者25例,共计进行42人次经腹肠道超声检查。对其病变肠壁、肠壁外腹部并发症的超声图像及小肠克罗恩病的活动度评估结果进行分析总结。结果病变肠壁表现:主要表现为肠壁增厚(41/42),多为全周性及全层性增厚,最厚段36人次位于下腹部,其中以右下腹最多(30/36,83.3%);活动期及严重者肠壁层次消失(16/42),僵硬,蠕动消失;26人次病变肠壁发现深达肠壁各层的溃疡。并发症表现:15人次出现狭窄,图像特征为肠壁增厚、肠腔变窄及近端肠管扩张;8人次出现瘘,图像特征为肠壁与其他器官之间的条状或分支状低回声带,含有或不含有气体强回声;爬行脂肪征30人次,图像特征为高回声脂肪团块包绕肠壁;肠系膜淋巴结炎20人次,其中18人次病灶长径<20 mm,为多发;腹腔积液16人次;腹部包块9人次,其中脓肿5人次,图像特征为炎性肿块内或肠系膜区局限性液区,透声差,无血流信号;穿孔1人次,超声图像表现为肠壁增厚,连续性中断,局部肠壁外见低回声区,腹腔内见游离液区,液区透声差;炎性息肉8人次,单发或多发,超声图像特征为凸入肠腔内的低回声或等回声凸起;憩室形成3人次,图像表现为局部肠壁变薄膨出,多位于系膜缘。活动期(超声评估)狭窄、爬行脂肪征、肠系膜淋巴结炎、腹腔积液等的发生率均明显高于缓解期(超声评估),差异均有统计学意义(P=0.002、0.000、0.024、0.025);活动期(超声评估)肠壁和爬行脂肪的最大厚度平均值明显大于缓解期(超声评估),差异均有统计学意义(P均=0.000)。超声与Harvey-Bradshaw指数对小肠克罗恩病活动性评估的一致性较好(Kappa=0.897,P <0.05)。结论经腹肠道超声能够清晰显示小肠克罗恩病的肠道病变及肠外并发症的改变,可以较准确地评估病变的活动度,且操作灵活,患者依从性好,可以作为小肠克罗恩病的常规影像学评估工具。更多还原

【Abstract】 Objective To analyze and summarize the ultrasonographic features of intestinal and periintestinal lesions in small intestinal Crohn’s disease(SICD). Methods Twenty-five patients with SICD who were admitted to Suzhou Hospital Affiliated to Nanjing Medical University from June 2009 to June 2019 were selected retrospectively, of whom 42 underwent transabdominal intestinal ultrasound examination. The ultrasound images of the diseased intestinal wall, abdominal complications, and activity assessment results of SICD were analyzed and summarized. Results The main manifestation of diseased small intestines was intestinal wall thickening(41/42), which was mostly annular and full-layered. Approximately 83.3%(30/36) of thickened segments of the intestines were located in the right lower quadrant(30/36). In active and severe cases, the layers of the intestinal wall disappeared(16/42), and the stiffness of the bowel increased, and peristalsis disappeared. In 26 of the diseased intestinal walls, deep ulcerations can be found in different layers of the wall. Fifteen patients had stenosis, and the image features were intestinal wall thickening and intestinal lumen narrowing with the expansion of the proximal intestine; 8 developed fistula, and the images showed linear echogenic or hypoechoic bands between the intestinal wall and other tissues, with or without strong gas echo; 30 had creeping fat, which manifested as hyper-echogenic mass-like fat around the diseased intestines; 20 developed mesenteric lymphadenitis, 90% of whom had lesions < 20 mm in length; 16 had ascites; 9 developed an abdominal mass, including 5 cases of abscess, and the image feature was localized fluid area in the inflammatory mass or mesenteric region, without blood flow signal; 1 developed perforation, and the image features were continuity interruption of a thickened bowel wall, and hypoechoic inflammatory area near the interruption area, with free fluid possibly found inside the abdominal cavity; 8 had inflammatory polyps, which manifested as one or more regular hypoechoic or iso-echoic masses protruding into the bowel lumen; and 3 had diverticulum, manifesting as thinning and swelling of local intestinal wall, mostly located at the mesangial margin. The incidence of stenosis, creeping fat sign, mesenteric lymphadenitis, and peritoneal effusion in the active phase(by ultrasound evaluation) was significantly higher than that in the remission phase(P=0.002, 0.000, 0.024, and 0.025, respectively). The mean maxium thickness of the intestinal wall and creeping fat in the active stage was significantly higher than that in the remission stage(P=0.000). There was a good consistency between ultrasound and Harvey Bradshaw index in assessing the activity of SICD(Kappa=0.897, P < 0.05). Conclusion Transabdominal bowel ultrasound can accurately show the classic features of Crohn’s disease as well as the complications frequently associated with the disease. The addition of color Doppler imaging may allow differentiation of chronic from active bowel wall thickening. Transabdominal bowel ultrasound can be used as a routine imaging assessment tool for SICD.更多还原