CT对急性肠梗阻的诊断价值研究
|
摘要
肠内容物不能正常运行、顺利通过肠道，称为肠梗阻（intestinalobstruction），是外科常见的病症。影像学检查是诊断急性肠梗阻的重要手段，传统的诊断方法仍以X线立位腹平片为首选。近年来随着CT（computertomography，电子计算机X射线断层扫描技术）的发展，其在急性肠梗阻的诊断中扮演越来越重要的地位。肠梗阻按发生的基本原因分为三类：机械性肠梗阻、动力性肠梗阻以及血运性肠梗阻，其中以机械性肠梗阻发病率最高。CT检查能够显示出传统腹部平片检查所不能显示的肠腔、肠壁的形态改变，对于不同类型急性肠梗阻都具有强大的定性及定位诊断价值。对于经常规胃肠减压、灌肠等对症治疗无好转而需行手术治疗的急性肠梗阻的病人，CT检查有可以提供充分的术前信息，以利于临床医生进行详细的术前评估。早期诊断急性肠梗阻既是临床中的难点，又是研究中的热点。本文旨在研究CT对急性肠梗阻的定位、定性诊断，以及对肠梗阻程度的判定价值。对我院胃肠外科2010年1月至2012年1月行手术治疗的急性肠梗阻患者64例进行回顾性研究，所有患者以手术和术后病理为定位、定性标准。所有患者于入院48小时内均行CT、立位腹平片及腹部彩超检查，由2名高年资医师用双盲法回顾性分析其CT、腹部平片，以及腹部彩超，在判断肠梗阻的部位、肠梗阻的病因，以及肠梗阻程度中的诊断价值。结果：64例患者中，CT检查明确诊断肠梗阻53例，灵敏度为82.8%（53/64），腹部平片检查明确诊断肠梗阻45例，灵敏度为70.3%(45/64)，腹部彩超检查明确诊断肠梗阻39例，灵敏度为60.9%（39/64）。在判断肠梗阻部位方面，以手术所见为金标准。64例患者中，高位肠梗阻（梗阻部位位于胃十二指肠、空肠上段）8例，低位肠梗阻（梗阻部位位于回肠、回盲部、结肠或直肠）56例。CT检查判断肠梗阻部位的准确率为62.5%（40/64），高位肠梗阻判断准确2例，低位肠梗阻判断准确38例，具体包括胃十二指肠梗阻2例（5%）、小肠梗阻20例（50%）、结肠梗阻10例（25%）、回盲部梗阻3例（7.5%）、直肠梗阻5例（12.5%）；而腹部平片检查判断肠梗阻部位的准确率仅为15.6%（10/64），全部为低位肠梗阻，其中小肠梗阻9例（90%），仅1例（10%）诊断为结肠梗阻；而腹部彩超检查通过肠腔内大量积气积液、腹腔内的游离液性暗区、梗阻近端肠管蠕动增强等间接影像诊断肠梗阻，受肠腔内积气积液等限制，判断的肠梗阻部位的准确率仅为14.1%（9/64），全部为低位肠梗阻，梗阻部位位于结肠，三种方法相比有明显的统计学意义（P<0.05），CT检查与腹部平片检查、CT检查与腹部彩超检查相比均相比有明显统计学意义（P<0.05）。在判断梗阻病因方面，以手术所见或术后病理为金标准，64例患者中，机械性肠梗阻56例，动力性肠梗阻8例。机械性肠梗阻中包括肿瘤34例（结直肠癌25例、小肠间质瘤1例、肾癌破裂1例、腹腔转移癌7例）、术后粘连7例、腹内（外）疝6例、肠套叠1例、肠扭转1例、粪石性肠梗阻3例、其他少见病4例；动力性肠梗阻中包括阑尾炎2例、盲肠炎1例，腹膜炎2例、盆腔脓肿1例、胰腺脓肿1例、小网膜囊肿1例。CT定性检查判断的准确率为45.3%（29/64）其中，机械性肠梗阻25例（86.2%），动力性肠梗阻4例（13.8%）。25例机械性肠梗阻中包括肿瘤19例、术后粘连1例、腹内疝2例、腹股沟斜疝1例、肠套叠1例、粪石性肠梗阻1例。4例动力性肠梗阻中包括盆腔脓肿1例、小网膜囊肿1例、胰腺脓肿1例、盲肠炎1例。腹部平片检查判断肠梗阻病因的准确率为0%（0/64），即没有1例诊断出肠梗阻的病因。腹部彩超判断肠梗阻病因的准确率为21.9%（14/64），包括肿瘤9例，腹内疝2例，胰腺脓肿1例，腹股沟斜疝1例，切口疝1例。CT检查与腹部平片检查、CT检查与腹部彩超检查、腹部平片检查与腹部彩超检查相比均有明显统计学意义（P<0.05）。64例患者中，手术方式主要为：结肠切除（包括左半结肠切除术、右半结肠切除术、乙状结肠切除术、结肠次全切除术）22例、单纯结肠造口术4例，肠切除、肠吻合术10例，肠粘连松解术9例，回盲部造口术11例，单纯腹腔镜探查或剖腹探查术2例、其他手术6例。其中经手术证实的绞窄性肠梗阻15例，10例行肠切除、肠吻合术，5例行肠粘连松解术。术前检查中CT检查10例考虑存在绞窄，腹部平片检查2例考虑存在绞窄，腹部彩超检查6例考虑存在绞窄，三种方法相比有明显统计学意义（P<0.05），CT检查与腹部平片检查相比有明显统计学意义（P<0.05），CT检查与腹部彩超相比无统计学意义（P>0.05）。结论：1、CT检查较腹部平片、彩超检查，更能准确诊断肠梗阻。2、在肠梗阻的定位诊断中，CT检查优于腹部平片及超声检查。3、在肠梗阻的定性诊断中，CT检查优于腹部平片及超声检查。4、在肠梗阻的程度判断中，CT检查优于腹部平片检查。5、CT应作为急性肠梗阻病人的常规检查方法之一。
Intestinal contents can not run smoothly through the intestinal tract,known as ileus (intestinal obstruction), which is a common disease insurgery. Imaging studies are important means of diagnosis of acute intestinalobstruction．The traditional diagnostic methods as the preferred are still X-rayorthostatic abdominal plain films. In recent years, with the development of CT(computer tomography), it plays an increasingly important role in the diagnosisof acute intestinal obstruction. According to the basic reason for the occurrenceof acute intestinal obstruction， it can be divided into three categories:mechanical intestinal obstruction、dynamic intestinal obstruction and bloodsupply intestinal obstruction, in which the incidence of mechanical intestinalobstruction is the highest. CT scan can show the morphological changes of theintestinal wall，which the traditional X-ray examination can not display, and, ithas strong qualitative and localizing diagnostic value for various types of acuteintestinal obstruction. For the patients of acute intestinal obstruction whohave no improvement through conventional decompression, sausage and othersymptomatic treatment and required surgical treatment, CT examination canprovide adequate preoperative information, in order to facilitate clinicians toconduct a detailed preoperative evaluation. The early diagnosis of acuteintestinal obstruction is not only a clinical difficulty, and also a hot topic in thestudy. This article aims to find the qualitative、localizing diagnostic value aswell as the value of assessment of the degree in acute intestinal obstruction. Itis a retrospective study on the patients who had a clear diagnosis of acuteintestinal obstruction by surgery and treated in the Gastrointestinal Surgery Department of our hospital from January2010to January2012, all patientshave undergone X-ray abdominal plain film in standing position and CT scan,within48hours since admitted to hospital. Two physicians analyze thediagnostic value in judgment、location、cause and degree of acute intestinalobstruction by retrospectively studying the performance of CT,X-rayabdominal plain film and abdominal ultrasonography by blinded method.Results:64patients, CT examination made clearly diagnosis of acute intestinalobstruction were53cases, the sensitivity was82.8%(53/64), the X-rayabdominal plain film confirmed the diagnosis of acute intestinal obstructionwere45cases, the sensitivity was70.3%(45/64), abdominal ultrasonographyconfirmed the diagnosis of acute intestinal obstruction were39cases, thesensitivity was60.9%(39/64). In the diagnosis of the location of acuteintestinal obstruction,surgical findings were the gold standards. The highintestinal obstruction (the site of obstruction in the stomach and duodenum andupper jejunum) were eight cases，and the low intestinal obstruction (the site ofobstruction in the ileum, ileocecal junction, colon or rectum)were56cases in64cases. the accuracy rate in location of CT scan was62.5%(40/64),two casesof high intestinal obstruction and38cases of low intestinalobstruction,including2cases (5%)of gastroduodenal obstruction,20cases(50%)of small intestinal obstruction,10cases (25%) of colon obstruction,3cases (7.5%)of ileocecal obstruction, and5cases(12.5%) of rectalobstruction.And the accuracy rate in location of X-ray abdominal plain filmwas15.6%(10/64), all for the low intestinal obstruction, of which9cases ofsmall bowel obstruction (90%), only1patient (10%) was diagnosed as colonicobstruction; Abdominal ultrasonography check through indirect imaging suchas a large number of product gas effusion, intra-abdominal free fluid areas,obstruction of proximal intestinal motility actively. Subject to the restrictions ofthe product gas effusion in the intestine, the accuracy rate in location of abdominal ultrasonography was only14.1%(9/64), all for the low intestinalobstruction, the site of obstruction in the colon.There was statisticallysignificant (P <0.05)by comparing the three methods, as well as comparing theCT examination and X-ray abdominal plain film, CT scan and abdominalultrasonography examination (P <0.05).In determining the cause of acuteintestinal obstruction, the surgical findings or postoperative pathology were thegold standards,56cases of mechanical intestinal obstruction, and8cases ofdynamic obstruction.In mechanical intestinal obstruction,there were34casesof tumors (25cases of colorectal cancer, one case of small intestinal stromaltumors, one case of kidney rupture,7cases of abdominal metastatic carcinoma),7cases of postoperative adhesions,6cases of intra-abdominal (outside) hernia,1case of intussusception,1case of volvulus,3cases of fecal obstruction,4cases of other rare diseases.In dynamic intestinal obstruction,there were2casesof appendicitis,1case of cecitis,2cases of peritonitis,1case of pelvic abscess,1case of pancreas abscess,1case of lesser omental cyst. The accuracy rate inthe judgement of the cause of acute intestinal obstruction of CT scan was45.3%(29/64).Among them, mechanical intestinal obstruction was25cases(86.2%), and dynamic intestinal obstruction was4cases (13.8%).25cases ofmechanical intestinal obstruction include19cases of tumors、1case ofpostoperative adhesion、2cases of abdominal hernia、one case of inguinalhernia、one case of intussusception and1cases of fecal obstruction.4cases ofdynamic intestinal obstruction include1case of pelvic abscess,1case of thelesser omental cyst,1case of pancreatic abscess,1case of appendicitis. Theaccuracy rate in the judgement of the cause of acute intestinal obstruction ofX-ray abdominal plain film was0%(0/64), that is, no one cases diagnosed thecause of acute intestinal obstruction.The accuracy rate in the judgement of thecause of acute intestinal obstruction of Abdominal ultrasonography was21.9%(14/64), including9cases of tumor,2cases of abdominal hernia,1case of pancreatic abscess,1case of inguinal hernia,1case of incisional hernia. Therewere statistically significant (P <0.05) by comparing CT scan and X-rayabdominal plain film, CT scan and abdominal ultrasonography examination,abdominal plain film examination and abdominal ultrasonography examination.
The surgery of the64patients:22cases of colonic resection (including lefthemicolectomy, right hemicolectomy, sigmoid resection, subtotal hysterectomyof colon)，4cases of simple colostomy,10cases of bowel resection andanastomosis,9cases of enterolysis performed,11cases of ileocecal resection,simple laparoscopy or exploratory laparotomy surgery were2cases. Of which15cases were strangulated intestinal obstruction confirmed by surgery,10patients underwent bowel resection and anastomosis,5patients underwententerolysis surgery. CT examination considering strangulation were10cases,X-ray abdominal plain film tconsidering strangulation were2cases, abdominalultrasonography examination considering strangulation were6cases.Therewere statistically significant difference (P <0.05) by comparing the threemethods, the CT examination and X-ray abdominal plain film examination,butthe CT examination and abdominal ultrasonography had no statisticallysignificant difference (P>0.05) between them. Conclusion:1.In diagnosis ofacute intestinal obstruction，CT examination is better than X-ray abdominalplain film and abdominal ultrasonography.2,In the diagnosis of location ofacute intestinal obstruction, CT scan is superior to X-ray abdominal plain filmand ultrasonography.3, in the qualitative diagnosis of acute intestinalobstruction, CT scan is superior to X-ray abdominal plain film andultrasonography.4, in the judgment of the extent of acute intestinal obstruction,CT scan is superior to X-ray abdominal plain film examination.5, CT shouldbe used as one of the routine examination of patients with acute intestinalobstruction.
Intestinal contents can not run smoothly through the intestinal tract,known as ileus (intestinal obstruction), which is a common disease insurgery. Imaging studies are important means of diagnosis of acute intestinalobstruction．The traditional diagnostic methods as the preferred are still X-rayorthostatic abdominal plain films. In recent years, with the development of CT(computer tomography), it plays an increasingly important role in the diagnosisof acute intestinal obstruction. According to the basic reason for the occurrenceof acute intestinal obstruction， it can be divided into three categories:mechanical intestinal obstruction、dynamic intestinal obstruction and bloodsupply intestinal obstruction, in which the incidence of mechanical intestinalobstruction is the highest. CT scan can show the morphological changes of theintestinal wall，which the traditional X-ray examination can not display, and, ithas strong qualitative and localizing diagnostic value for various types of acuteintestinal obstruction. For the patients of acute intestinal obstruction whohave no improvement through conventional decompression, sausage and othersymptomatic treatment and required surgical treatment, CT examination canprovide adequate preoperative information, in order to facilitate clinicians toconduct a detailed preoperative evaluation. The early diagnosis of acuteintestinal obstruction is not only a clinical difficulty, and also a hot topic in thestudy. This article aims to find the qualitative、localizing diagnostic value aswell as the value of assessment of the degree in acute intestinal obstruction. Itis a retrospective study on the patients who had a clear diagnosis of acuteintestinal obstruction by surgery and treated in the Gastrointestinal Surgery Department of our hospital from January2010to January2012, all patientshave undergone X-ray abdominal plain film in standing position and CT scan,within48hours since admitted to hospital. Two physicians analyze thediagnostic value in judgment、location、cause and degree of acute intestinalobstruction by retrospectively studying the performance of CT,X-rayabdominal plain film and abdominal ultrasonography by blinded method.Results:64patients, CT examination made clearly diagnosis of acute intestinalobstruction were53cases, the sensitivity was82.8%(53/64), the X-rayabdominal plain film confirmed the diagnosis of acute intestinal obstructionwere45cases, the sensitivity was70.3%(45/64), abdominal ultrasonographyconfirmed the diagnosis of acute intestinal obstruction were39cases, thesensitivity was60.9%(39/64). In the diagnosis of the location of acuteintestinal obstruction,surgical findings were the gold standards. The highintestinal obstruction (the site of obstruction in the stomach and duodenum andupper jejunum) were eight cases，and the low intestinal obstruction (the site ofobstruction in the ileum, ileocecal junction, colon or rectum)were56cases in64cases. the accuracy rate in location of CT scan was62.5%(40/64),two casesof high intestinal obstruction and38cases of low intestinalobstruction,including2cases (5%)of gastroduodenal obstruction,20cases(50%)of small intestinal obstruction,10cases (25%) of colon obstruction,3cases (7.5%)of ileocecal obstruction, and5cases(12.5%) of rectalobstruction.And the accuracy rate in location of X-ray abdominal plain filmwas15.6%(10/64), all for the low intestinal obstruction, of which9cases ofsmall bowel obstruction (90%), only1patient (10%) was diagnosed as colonicobstruction; Abdominal ultrasonography check through indirect imaging suchas a large number of product gas effusion, intra-abdominal free fluid areas,obstruction of proximal intestinal motility actively. Subject to the restrictions ofthe product gas effusion in the intestine, the accuracy rate in location of abdominal ultrasonography was only14.1%(9/64), all for the low intestinalobstruction, the site of obstruction in the colon.There was statisticallysignificant (P <0.05)by comparing the three methods, as well as comparing theCT examination and X-ray abdominal plain film, CT scan and abdominalultrasonography examination (P <0.05).In determining the cause of acuteintestinal obstruction, the surgical findings or postoperative pathology were thegold standards,56cases of mechanical intestinal obstruction, and8cases ofdynamic obstruction.In mechanical intestinal obstruction,there were34casesof tumors (25cases of colorectal cancer, one case of small intestinal stromaltumors, one case of kidney rupture,7cases of abdominal metastatic carcinoma),7cases of postoperative adhesions,6cases of intra-abdominal (outside) hernia,1case of intussusception,1case of volvulus,3cases of fecal obstruction,4cases of other rare diseases.In dynamic intestinal obstruction,there were2casesof appendicitis,1case of cecitis,2cases of peritonitis,1case of pelvic abscess,1case of pancreas abscess,1case of lesser omental cyst. The accuracy rate inthe judgement of the cause of acute intestinal obstruction of CT scan was45.3%(29/64).Among them, mechanical intestinal obstruction was25cases(86.2%), and dynamic intestinal obstruction was4cases (13.8%).25cases ofmechanical intestinal obstruction include19cases of tumors、1case ofpostoperative adhesion、2cases of abdominal hernia、one case of inguinalhernia、one case of intussusception and1cases of fecal obstruction.4cases ofdynamic intestinal obstruction include1case of pelvic abscess,1case of thelesser omental cyst,1case of pancreatic abscess,1case of appendicitis. Theaccuracy rate in the judgement of the cause of acute intestinal obstruction ofX-ray abdominal plain film was0%(0/64), that is, no one cases diagnosed thecause of acute intestinal obstruction.The accuracy rate in the judgement of thecause of acute intestinal obstruction of Abdominal ultrasonography was21.9%(14/64), including9cases of tumor,2cases of abdominal hernia,1case of pancreatic abscess,1case of inguinal hernia,1case of incisional hernia. Therewere statistically significant (P <0.05) by comparing CT scan and X-rayabdominal plain film, CT scan and abdominal ultrasonography examination,abdominal plain film examination and abdominal ultrasonography examination.
The surgery of the64patients:22cases of colonic resection (including lefthemicolectomy, right hemicolectomy, sigmoid resection, subtotal hysterectomyof colon)，4cases of simple colostomy,10cases of bowel resection andanastomosis,9cases of enterolysis performed,11cases of ileocecal resection,simple laparoscopy or exploratory laparotomy surgery were2cases. Of which15cases were strangulated intestinal obstruction confirmed by surgery,10patients underwent bowel resection and anastomosis,5patients underwententerolysis surgery. CT examination considering strangulation were10cases,X-ray abdominal plain film tconsidering strangulation were2cases, abdominalultrasonography examination considering strangulation were6cases.Therewere statistically significant difference (P <0.05) by comparing the threemethods, the CT examination and X-ray abdominal plain film examination,butthe CT examination and abdominal ultrasonography had no statisticallysignificant difference (P>0.05) between them. Conclusion:1.In diagnosis ofacute intestinal obstruction，CT examination is better than X-ray abdominalplain film and abdominal ultrasonography.2,In the diagnosis of location ofacute intestinal obstruction, CT scan is superior to X-ray abdominal plain filmand ultrasonography.3, in the qualitative diagnosis of acute intestinalobstruction, CT scan is superior to X-ray abdominal plain film andultrasonography.4, in the judgment of the extent of acute intestinal obstruction,CT scan is superior to X-ray abdominal plain film examination.5, CT shouldbe used as one of the routine examination of patients with acute intestinalobstruction.
引文
[1] Hotta T, Takifuji K, Kobayashi Y, et al.Management of obstructivecolorectal cancer: evaluation of preoperative bowel decompression usingileus tube drainage[J].Surg Today.2012Jan13.
[2] Yokohata K, Sumiyoshi K, Hirakawa K,et al. Merits and faults of transanalileus tube for obstructing colorectal cancer[J].Asian J Surg.2006,29(3):125-7.
[3] Nozoe T, Matsumata T.Usefulness of preoperative colonic lavage usingtransanal ileus tube for obstructing carcinoma of left colon: device toperform one-stage operation safely[J].J Clin Gastroenterol.2000,31(2):156-8.
[4] Cai X, Song X, Cai X.Strangulated intestinal obstruction secondary to atypical obturator hernia: a case report with literature review[J]. Int J MedSci.2012,9(3):213-5.
[5] Galeev YM, Lishmanov YB, Grigorev EG, et al.Scintigraphic visualizationof bacterial translocation in experimental strangulated intestinalobstruction[J].Eur J Nucl Med Mol Imaging.2009Nov;36(11):1822-8.
[6] Silva AC,Pimenta M,Guimaraes LS.Small bowel obstruction: what to lookfor[J]. Radiographics,2009,29:423-439．
[7] Tracy A,Jaffed MD,Lucie C,et al.Small-Bowel Obstruction: CoronalReformations from Isotropic Voxels at16-Section Multi–Detector RowCT[J].Radiology,2006,238(1):135-142.
[8]杨忠福,郭旭.多层螺旋ＣＴ在肠梗阻病因诊断中的价值[J].实用放射学杂志,2010,26(4):520-522,525.
[9] Kidmas AT，Ekedigwe JE，Sule AZ，et al．A review of the radiologicaldiagnosis of small bowel obstruction using various imaging modalities.Niger Postgrad Med[J].2005,12:33.
[10]瞿彩兴,许志云.172例老年人急性肠梗阻的病因及其治疗[J].医学创新研究.2008,5(24):12-13.
[11]11.S. Aufort,L. Charra,A. Lesnik,et al.Multidetector CT of bowelobstruction:value of post-processing[J].Eur Radiol,2005,15:2323–2329.
[12]周彤，伍晓汀，周业江，等．腹部ｘ线、超声、CT检查对肠梗阻诊断的临床分析[J]．实用临床医药杂志，2006,10:53-55.
[13]唐显映,张小明,董国礼,等.肠梗阻的腹部X线平片和CT诊断[J].医学影像学杂志，2005,15（1）：50-52.
[14]明兵,李振勋,高源统,等.CT在机械性肠梗阻诊断中的作用[J].中华放射学杂志,2002,36(10):896-900.
[15] Tracy A,Jaffed MD,Lucie C,et al.Small-Bowel Obstruction: CoronalReformations from Isotropic Voxels at16-Section Multi–Detector RowCT[J].Radiology,2006,238(1):135-142.
[16]潘秀.超声诊断早期绞窄性小肠梗阻的临床价值(附148例报告)[J].中国医师杂志,2002,4(3):239-240.
[17] S chmutz GR, Benko A, Fournier L, et al. Small bowel obstruction: roleand contribution of sonography. Eur Radiol,1997,7:1054-1058.
[18]张晓鹏.肠梗阻的CT与螺旋CT诊断[J].中国实用外科杂志,2000年,20(3):190-191.
[19] Donckier V, Closset J, Van Gansbeke D, et al.Contribution of computedtomography to decision making in the management of adhesive SBO[J]. BrJ Surg,1998,85:1071–1074.
[20] Daneshmand S, Hedley CG, Stain SC.The utility and reliability ofcomputed tomography scan in the diagnosis of SBO[J]. AmSurg,1999,65:922–926.
[21] Jerome Hodel,Marc Zins, Loic Desmottes,Isabelle Boulay-Coletta, MarieChristine Julles,Jean Pierre Nakache, Mathieu Rodallec.Location of thetransition zone in CT of small-bowel obstruction: added value ofmultiplanar reformations[J].Abdom Imaging,(2009)34:35–41.
[22]吴在德，吴肇汉，主编.外科学[M].第七版，北京：人民卫生出版社，2007,451-452.
[23] Paulson EK,Jaffe AJ,Thomas J,et al.MDCT of patients with abdominalpain:a new perspective using coronal reformations cute form submillimeterisotropic voxels[J].AJR,2004,183:899-906.[16]
[24]寇井泉,韩华.结肠梗阻的综合诊断意义[J].医用放射技术杂志,2005,241:68-69.
[25] Qingbing Wang, Dengbin Wang.Abdominal cocoon: multi-detector rowCT with multiplanar reformation and review of literatures[J].AbdomImaging,2010,35:92–94.
[26] Tombak MC, Apayd in FD, Colak T, et al. An unusual cause of intestinalobstruction: abdominal cocoon[J]. A JR Am J Roentgeno,2010,194(2):176-178.
[27] Lee K,Kindo H, Gorden DL, et al.Selective laparoscopic magement ofadhesive small bowel obstruction using CT guidance[J]. AmSurg,2009,75(3):227-231.
[28]宣家文,翟建,俞咏梅,等.多层螺旋CT多期扫描对闭袢性小肠梗阻肠壁缺血判断的实验研究[J].实用放射学杂志,2009,25(1):108-112.
[29]丁佩媛，王永仁.绞窄性小肠梗阻的X线和CT诊断价值[J].医学信息，2011,3:2766-2767.
[30]李文华，曹庆选，杨世锋，等.绞窄性肠梗阻肠系膜及其血管改变的CT研究[J].中华放射学杂志，2006,40（1）：81-85.
[31] Macari M,Chandarana H,Balthazar E. Intestinal ischemia versus intramuralhemorrhage:CT evaluation[J].AJR,2003,180:177-184.
[32]姬永浩,顿国亮,刘建学,等.绞窄性肠梗阻患者彩色多普勒超声表现[J].中华医学超声杂志（电子版）,2012,9(2):146-147.
[33] Swati D. Deshmukh,David S. Shin,Juergen K.Willmann,JarrettRosenberg,Lewis Shin,R. Brooke Jeffrey.Non-emergency small bowelobstruction: assessment of CT findings that predict need for surgery[J].EurRadiol,2011,21:982–986.
[1]吴在德，吴肇汉，外科学（第七版），人民卫生出版社，451-452．
[2] Silva AC,Pimenta M,Guimaraes LS.Small bowel obstruction: what to lookfor[J]. Radiographics,2009,29:423-439．
[3] Tracy A,Jaffed MD,Lucie C,et al.Small-Bowel Obstruction: CoronalReformations from Isotropic Voxels at16-Section Multi–Detector RowCT[J].Radiology,2006,238(1):135-142.
[4]杨忠福,郭旭.多层螺旋ＣＴ在肠梗阻病因诊断中的价值[J].实用放射学杂志,2010,26(4):520-522,525.
[5] Delabrousse E，Lubrano J，Sailley N，et al．Small-bowel bezoar versussmall‐bowel feces：C T evaluation［J］．AJR，2008，191：1465-1468．
[6]周连高，翁晔敏，林静，等．小肠梗阻的ＣＴ诊断[J]．中国中西医结合影像学杂志，2011，9（3）：250-252．
[7] Chao HC, Chang KW, Wang CJ.Intestinal obstruction caused by potatobezoar in infancy: a report of three cases[J].Pediatr Neonatol.2012Apr;53(2):151-3.
[8]季建松，王祖飞，赵中伟，等.螺旋CT及重建技术对肿瘤性肠梗阻的诊断价值［J］.实用放射学杂志，2006，23（2）：46-49．
[9]黄国来，姚伟根，徐达君，等.粪石性肠梗阻螺旋CT诊断价值[J].浙江中西医结合杂志,2011,21(1):36-37．
[10]周红英，胡茂清，金志发，等.胆石性肠梗阻的X线及CT表现[J].中国CT和MRI杂志,2011,9(1):48-50.
[11] Delabrousse E, Baulard R, Sarlieve P, et a l. Value of the small bowelfeces sign at CT in adhesive small bow el obstruction [J].Radio,l2005,86(4):393-398．
[12]陈国平,狄海庭．粘连性肠梗阻及其亚型的CT诊断[J].医学综述,2010,16(23):3662-3664.
[13] Tombak MC, Apayd in FD, Colak T, et al. An unusual cause of intestinalobstruction: abdominal cocoon[J]. A JR Am J Roentgeno,2010,194(2):176-178.
[14] Qingbing Wang, Dengbin Wang.Abdominal cocoon: multi-detector rowCT with multiplanar reformation and review of literatures[J].AbdomImaging,2010,35:92–94.
[15]包迎伟，纪建松，傅立平，等．螺旋CT对肠扭转的诊断价值[J]．放射学实践，2010，25（1）：80-82．
[16]王丽娟，李忠，张起双.16层螺旋CT及多平面重建在肠扭转中的诊断价值[J].内蒙古民族大学学报,2010,25(6):697-699,709.
[17] Mark E，Lockhart，Franklin N，et al. Internal Hernia After GastricBypass:Sensitivity and Specificity of Seven CT Signs with SurgicalCorrelation and Controls [J]．Am J Roentgenol，2007，188（3）：745－750.
[18] Laura R，Carucci，Turner MA，et al. Internal Hernia Following Roux－en－Y Gastric Bypass Surgery for Morbid Obesity： Evaluation ofRadiographic Findings at Small Bowel Examination［J］．Radiology，2009，251（6）：762-770.
[19] Akbulut S.Unusual cause of intestinal obstruction: left paraduodenalhernia[J].Case Report Med.2012.
[20] Brehm V, Smithuis R, Doornebosch PG. A left paraduodenal herniacausing acute bowel obstruction: a case report. Acta Chirurgica Belgica.2006;106(4):436–437.
[21]孙承，刘燕，汪登斌，等.结肠癌致肠梗阻的ＣＴ诊断[J].中国医学计算机成像杂志，2007,13（3）：189-193.
[22]徐艳.结肠癌合并肠梗阻的CT诊断价值[J].中国现代药物应用,2010,4(23):67-68.
[23] Ghionzoli M， James CP， David AL，et al．Gastroschisis with intestinalatresia－predictive value of antenatal diagnosis and outcome of postnataltreatment [J]．J Pediatr Surg.2012，47(2):322-8．
[24]汪雪源，许中友，李定跃，等．动力性肠梗阻的发病原因和诊治分析[J].现代实用医学,2010,22(10):1121-1122.
[25]汪大海,蔡文芳,戴永泽.62例假性肠梗阻的治疗体会[J].中国民康医学,2009,21(15):1855.
[26]杜晓辉，李荣，梁发启．急性血运性肠梗阻的诊治(附35例报告)[J].中国现代医学杂志，2006，05
[27]吕云福,李新秋,黄伟炜,等.绞窄性肠梗阻诊断指标的分析[J].中华胃肠外科杂志，2007,10（6）：583-584.
[28]肖锋.多层螺旋CT扫描对绞窄性肠梗阻肠壁缺血坏死的诊断价值[J].中国医药导报,2009,6(21):87-88.
[29]李文华，曹庆选，杨世锋，等.绞窄性肠梗阻肠系膜及其血管改变的CT研究[J].中华放射学杂志，2006,40（1）：81-85.
[30] Macari M,Chandarana H,Balthazar E. Intestinal ischemia versusintramural hemorrhage:CT evaluation[J].AJR,2003,180:177-184.
[2] Yokohata K, Sumiyoshi K, Hirakawa K,et al. Merits and faults of transanalileus tube for obstructing colorectal cancer[J].Asian J Surg.2006,29(3):125-7.
[3] Nozoe T, Matsumata T.Usefulness of preoperative colonic lavage usingtransanal ileus tube for obstructing carcinoma of left colon: device toperform one-stage operation safely[J].J Clin Gastroenterol.2000,31(2):156-8.
[4] Cai X, Song X, Cai X.Strangulated intestinal obstruction secondary to atypical obturator hernia: a case report with literature review[J]. Int J MedSci.2012,9(3):213-5.
[5] Galeev YM, Lishmanov YB, Grigorev EG, et al.Scintigraphic visualizationof bacterial translocation in experimental strangulated intestinalobstruction[J].Eur J Nucl Med Mol Imaging.2009Nov;36(11):1822-8.
[6] Silva AC,Pimenta M,Guimaraes LS.Small bowel obstruction: what to lookfor[J]. Radiographics,2009,29:423-439．
[7] Tracy A,Jaffed MD,Lucie C,et al.Small-Bowel Obstruction: CoronalReformations from Isotropic Voxels at16-Section Multi–Detector RowCT[J].Radiology,2006,238(1):135-142.
[8]杨忠福,郭旭.多层螺旋ＣＴ在肠梗阻病因诊断中的价值[J].实用放射学杂志,2010,26(4):520-522,525.
[9] Kidmas AT，Ekedigwe JE，Sule AZ，et al．A review of the radiologicaldiagnosis of small bowel obstruction using various imaging modalities.Niger Postgrad Med[J].2005,12:33.
[10]瞿彩兴,许志云.172例老年人急性肠梗阻的病因及其治疗[J].医学创新研究.2008,5(24):12-13.
[11]11.S. Aufort,L. Charra,A. Lesnik,et al.Multidetector CT of bowelobstruction:value of post-processing[J].Eur Radiol,2005,15:2323–2329.
[12]周彤，伍晓汀，周业江，等．腹部ｘ线、超声、CT检查对肠梗阻诊断的临床分析[J]．实用临床医药杂志，2006,10:53-55.
[13]唐显映,张小明,董国礼,等.肠梗阻的腹部X线平片和CT诊断[J].医学影像学杂志，2005,15（1）：50-52.
[14]明兵,李振勋,高源统,等.CT在机械性肠梗阻诊断中的作用[J].中华放射学杂志,2002,36(10):896-900.
[15] Tracy A,Jaffed MD,Lucie C,et al.Small-Bowel Obstruction: CoronalReformations from Isotropic Voxels at16-Section Multi–Detector RowCT[J].Radiology,2006,238(1):135-142.
[16]潘秀.超声诊断早期绞窄性小肠梗阻的临床价值(附148例报告)[J].中国医师杂志,2002,4(3):239-240.
[17] S chmutz GR, Benko A, Fournier L, et al. Small bowel obstruction: roleand contribution of sonography. Eur Radiol,1997,7:1054-1058.
[18]张晓鹏.肠梗阻的CT与螺旋CT诊断[J].中国实用外科杂志,2000年,20(3):190-191.
[19] Donckier V, Closset J, Van Gansbeke D, et al.Contribution of computedtomography to decision making in the management of adhesive SBO[J]. BrJ Surg,1998,85:1071–1074.
[20] Daneshmand S, Hedley CG, Stain SC.The utility and reliability ofcomputed tomography scan in the diagnosis of SBO[J]. AmSurg,1999,65:922–926.
[21] Jerome Hodel,Marc Zins, Loic Desmottes,Isabelle Boulay-Coletta, MarieChristine Julles,Jean Pierre Nakache, Mathieu Rodallec.Location of thetransition zone in CT of small-bowel obstruction: added value ofmultiplanar reformations[J].Abdom Imaging,(2009)34:35–41.
[22]吴在德，吴肇汉，主编.外科学[M].第七版，北京：人民卫生出版社，2007,451-452.
[23] Paulson EK,Jaffe AJ,Thomas J,et al.MDCT of patients with abdominalpain:a new perspective using coronal reformations cute form submillimeterisotropic voxels[J].AJR,2004,183:899-906.[16]
[24]寇井泉,韩华.结肠梗阻的综合诊断意义[J].医用放射技术杂志,2005,241:68-69.
[25] Qingbing Wang, Dengbin Wang.Abdominal cocoon: multi-detector rowCT with multiplanar reformation and review of literatures[J].AbdomImaging,2010,35:92–94.
[26] Tombak MC, Apayd in FD, Colak T, et al. An unusual cause of intestinalobstruction: abdominal cocoon[J]. A JR Am J Roentgeno,2010,194(2):176-178.
[27] Lee K,Kindo H, Gorden DL, et al.Selective laparoscopic magement ofadhesive small bowel obstruction using CT guidance[J]. AmSurg,2009,75(3):227-231.
[28]宣家文,翟建,俞咏梅,等.多层螺旋CT多期扫描对闭袢性小肠梗阻肠壁缺血判断的实验研究[J].实用放射学杂志,2009,25(1):108-112.
[29]丁佩媛，王永仁.绞窄性小肠梗阻的X线和CT诊断价值[J].医学信息，2011,3:2766-2767.
[30]李文华，曹庆选，杨世锋，等.绞窄性肠梗阻肠系膜及其血管改变的CT研究[J].中华放射学杂志，2006,40（1）：81-85.
[31] Macari M,Chandarana H,Balthazar E. Intestinal ischemia versus intramuralhemorrhage:CT evaluation[J].AJR,2003,180:177-184.
[32]姬永浩,顿国亮,刘建学,等.绞窄性肠梗阻患者彩色多普勒超声表现[J].中华医学超声杂志（电子版）,2012,9(2):146-147.
[33] Swati D. Deshmukh,David S. Shin,Juergen K.Willmann,JarrettRosenberg,Lewis Shin,R. Brooke Jeffrey.Non-emergency small bowelobstruction: assessment of CT findings that predict need for surgery[J].EurRadiol,2011,21:982–986.
[1]吴在德，吴肇汉，外科学（第七版），人民卫生出版社，451-452．
[2] Silva AC,Pimenta M,Guimaraes LS.Small bowel obstruction: what to lookfor[J]. Radiographics,2009,29:423-439．
[3] Tracy A,Jaffed MD,Lucie C,et al.Small-Bowel Obstruction: CoronalReformations from Isotropic Voxels at16-Section Multi–Detector RowCT[J].Radiology,2006,238(1):135-142.
[4]杨忠福,郭旭.多层螺旋ＣＴ在肠梗阻病因诊断中的价值[J].实用放射学杂志,2010,26(4):520-522,525.
[5] Delabrousse E，Lubrano J，Sailley N，et al．Small-bowel bezoar versussmall‐bowel feces：C T evaluation［J］．AJR，2008，191：1465-1468．
[6]周连高，翁晔敏，林静，等．小肠梗阻的ＣＴ诊断[J]．中国中西医结合影像学杂志，2011，9（3）：250-252．
[7] Chao HC, Chang KW, Wang CJ.Intestinal obstruction caused by potatobezoar in infancy: a report of three cases[J].Pediatr Neonatol.2012Apr;53(2):151-3.
[8]季建松，王祖飞，赵中伟，等.螺旋CT及重建技术对肿瘤性肠梗阻的诊断价值［J］.实用放射学杂志，2006，23（2）：46-49．
[9]黄国来，姚伟根，徐达君，等.粪石性肠梗阻螺旋CT诊断价值[J].浙江中西医结合杂志,2011,21(1):36-37．
[10]周红英，胡茂清，金志发，等.胆石性肠梗阻的X线及CT表现[J].中国CT和MRI杂志,2011,9(1):48-50.
[11] Delabrousse E, Baulard R, Sarlieve P, et a l. Value of the small bowelfeces sign at CT in adhesive small bow el obstruction [J].Radio,l2005,86(4):393-398．
[12]陈国平,狄海庭．粘连性肠梗阻及其亚型的CT诊断[J].医学综述,2010,16(23):3662-3664.
[13] Tombak MC, Apayd in FD, Colak T, et al. An unusual cause of intestinalobstruction: abdominal cocoon[J]. A JR Am J Roentgeno,2010,194(2):176-178.
[14] Qingbing Wang, Dengbin Wang.Abdominal cocoon: multi-detector rowCT with multiplanar reformation and review of literatures[J].AbdomImaging,2010,35:92–94.
[15]包迎伟，纪建松，傅立平，等．螺旋CT对肠扭转的诊断价值[J]．放射学实践，2010，25（1）：80-82．
[16]王丽娟，李忠，张起双.16层螺旋CT及多平面重建在肠扭转中的诊断价值[J].内蒙古民族大学学报,2010,25(6):697-699,709.
[17] Mark E，Lockhart，Franklin N，et al. Internal Hernia After GastricBypass:Sensitivity and Specificity of Seven CT Signs with SurgicalCorrelation and Controls [J]．Am J Roentgenol，2007，188（3）：745－750.
[18] Laura R，Carucci，Turner MA，et al. Internal Hernia Following Roux－en－Y Gastric Bypass Surgery for Morbid Obesity： Evaluation ofRadiographic Findings at Small Bowel Examination［J］．Radiology，2009，251（6）：762-770.
[19] Akbulut S.Unusual cause of intestinal obstruction: left paraduodenalhernia[J].Case Report Med.2012.
[20] Brehm V, Smithuis R, Doornebosch PG. A left paraduodenal herniacausing acute bowel obstruction: a case report. Acta Chirurgica Belgica.2006;106(4):436–437.
[21]孙承，刘燕，汪登斌，等.结肠癌致肠梗阻的ＣＴ诊断[J].中国医学计算机成像杂志，2007,13（3）：189-193.
[22]徐艳.结肠癌合并肠梗阻的CT诊断价值[J].中国现代药物应用,2010,4(23):67-68.
[23] Ghionzoli M， James CP， David AL，et al．Gastroschisis with intestinalatresia－predictive value of antenatal diagnosis and outcome of postnataltreatment [J]．J Pediatr Surg.2012，47(2):322-8．
[24]汪雪源，许中友，李定跃，等．动力性肠梗阻的发病原因和诊治分析[J].现代实用医学,2010,22(10):1121-1122.
[25]汪大海,蔡文芳,戴永泽.62例假性肠梗阻的治疗体会[J].中国民康医学,2009,21(15):1855.
[26]杜晓辉，李荣，梁发启．急性血运性肠梗阻的诊治(附35例报告)[J].中国现代医学杂志，2006，05
[27]吕云福,李新秋,黄伟炜,等.绞窄性肠梗阻诊断指标的分析[J].中华胃肠外科杂志，2007,10（6）：583-584.
[28]肖锋.多层螺旋CT扫描对绞窄性肠梗阻肠壁缺血坏死的诊断价值[J].中国医药导报,2009,6(21):87-88.
[29]李文华，曹庆选，杨世锋，等.绞窄性肠梗阻肠系膜及其血管改变的CT研究[J].中华放射学杂志，2006,40（1）：81-85.
[30] Macari M,Chandarana H,Balthazar E. Intestinal ischemia versusintramural hemorrhage:CT evaluation[J].AJR,2003,180:177-184.