摘要
目的 总结结肠癌肠梗阻CT检查影像学特征,为临床诊断结肠癌肠梗阻提供影像学依据.方法 回顾性分析2012年6月至2015年3月南京医科大学附属无锡第二医院收治的33例结肠癌肠梗阻患者的临床资料.患者行CT腹部平扫和双期增强扫描,总结其影像学资料.结果 33例结肠癌肠梗阻患者中,梗阻位于升结肠9例,结肠肝曲2例,横结肠7例,结肠脾曲3例,降结肠3例,乙状结肠7例,直肠乙状结肠2例.33例患者梗阻段肠壁不规则增厚,肠腔不均匀狭窄.肠壁平均厚度1.9 cm（0.6～3.2 cm）.狭窄段长度：2.0 ～3.0cm3例,3.1～4.0 cm3例,4.1～5.0 cm 11例,5.1 ～8.0 cm 12例,＞8.0 cm 4例,33例患者狭窄段平均长度为5.8 cm.狭窄段直径0～0.5 cm,平均直径0.2 cm.僵硬不规则增厚的肠壁与正常肠壁交界处呈“袖口征”（7例）或“肩征”（5例）.梗阻段以上肠管扩张,26例呈多发液气平面,7例以气体为主.29例患者梗阻近端肠管明显扩张,梗阻近端右侧结肠扩张直径约为6.0 cm,左侧结肠扩张直径约为4.0 cm,梗阻远端肠管塌陷.33例患者均有不同程度的盲肠扩张,肠管平均直径为6.9 cm.3例患者结肠癌近端肠壁缺血水肿,为缺血性结肠炎,其中1例穿孔,膈下见游离气体.25例患者结肠癌侵犯浆膜层或周围器官,边界不清晰,周围见索条影、结节影.14例患者淋巴结转移,结肠癌周围或腹膜后淋巴结不均匀强化,内见坏死,淋巴结边缘毛糙,部分周边条形渗出.3例患者肝转移,1例肺转移.结论 肠壁不规则增厚,肠腔不均匀狭窄,与正常肠壁交界处呈“袖口征”或“肩征”,梗阻段以上肠管扩张,呈多发液气平是结肠癌肠梗阻的CT检查影像学特征.
Objective To summarize the imaging characteristics and clinical diagnostic value of computed tomography （CT） examination in colon cancer combined with obstruction.Methods The clinical data of 33 patients with colon cancer combined with obstruction who were admitted to the Wuxi No.2 People＆#39;s Hospital from June 2012 to March 2015 were retrospectively analyzed.All the patients received abdomianl plain scan and dualphase enhanced scan of CT,and the imaging data were summarized.Results Of 33 patients with colon cancer combined with obstruction,obstruction was located at the ascending colon in 9 patients,hepatic flexure of the colon in 2 patients,colon transverse in 7 patients,splenic flexure of the colon in 3 patients,descending colon in 3 patients,sigmoid colon in 7 patients and proctosigmoid in 2 patients.Thirty-three patients had irregular and thickened colonic wall at the obstructive segment and irregular constriction of colonic lumen,with a mean coloric wall thickness of 1.9 cm （range,0.6-3.2 cm）.The length of constriction was 2.0-3.0 cm in 3 patients,3.1-4.0 cm in 3 patients,4.1-5.0 cm in 11 patients,5.1-8.0 cm in 12 patients and more than 8.0 cm in 4 patients.The mean length,diameter and mean diameter of the constriction of 33 patients were 5.8 cm,0-0.5 cm and 0.2 cm.The performance at the junction of the normal wall and the stenosis was scuff syndrome in 7 patients and shoulder symptoms in 5 patients.Colonic dilatation above the obstructive segment was detected in 26 patients with multiple gas-fluid levels and in 7 patients with mainly gas.Twenty-nine patients had colonic dilatation at the proximal end of obstruction with the diameter of right colonic dilatation of 6.0 cm,diameter of left colonic dilatation of 4.0 cm and colonic collapse at the distal end of obstruction.Thirty-three patients had different grades of cecal dilatation with a mean diameter of 6.9 cm.Three patients had ischemic colitis including 1 patient with colonic perforation and free underarm gas.The serosal invasion or organ involvement of colon cancer was detected in 25 patients with unclear boundary and cable-strip or nodular opacities.Fourteen patients had lymph node metastases,with surrounding tumor or retroperitoneal heterogeneous enhancement,sacvariable necrosis area,short-tempered edge of lymph node,bar-type exudation surrounding some of lymph node.There was 3 patients with hepatic metastases and 1 with pulmonary metastasis.Conclusion Irregular and thickened colonic wall,irregular constriction of colonic lumen,scuff syndrome and shoulder symptoms at the junction of the normal wall,colonic dilatation above the obstructive segment and multiple gas-fluid levels are mainly characterics of CT examination for colon cancer combined with obstruction.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第6期507-510,共4页
Chinese Journal of Digestive Surgery
关键词
结肠肿瘤
肠梗阻
X线计算机断层成像
Colonic neoplasms
Intestinal obstruction
Computed tomography,X-ray
