王刚+周晓明+赵蕊蕊+于澜+李志明

[摘要] 目的 评价256层螺旋CT小肠造影扫描技术对小肠疾病的诊断作用。方法 给予2015年1月—2017年1月300例临床怀疑小肠疾病患者256层螺旋CT小肠造影扫描，观察患者病变的位置、形态、大小、转移及周围侵犯情况，将256层螺旋CT小肠造影扫描结果与临床诊断进行对比分析。 结果 300例行256层螺旋CT小肠造影扫描检查的患者，244例诊断为小肠病变，与临床诊断一致。56例患者256层螺旋CT小肠造影扫描诊断为阴性，其中符合40例，漏诊11例，误诊5例。256层螺旋CT小肠造影扫描诊断小肠疾病的灵敏度为93.8%（244/260），準确率为94.7%（284/300）；阳性预测值为100%，阴性预测值为71.4%。结论 256层螺旋CT小肠造影扫描诊断小肠肿瘤、炎症、梗阻等疾病具有特征性表现，对小肠疾病的诊治具有重要意义，临床推广价值极好。

[关键词] 256层螺旋CT小肠造影扫描；小肠疾病；临床诊断；特征性表现

[中图分类号] R574 [文献标识码] A [文章编号] 1674-0742（2017）05（c）-0183-03

[Abstract] Objective To evaluate the clinical application value of 256-slice spiral CT small intestine radiography scanning technique in diagnosis of small intestine diseases. Methods 300 cases of patients suspected with small intestine diseases in clinic from January 2015 to January 2017 were selected for 256-slice spiral CT small intestine radiography scanning， and the lesion position， shape， size， metastasis and peripheral invasion， and the scanning results and clinical diagnosis results were compared and analyzed. Results Of 300 cases of patients with 256-slice spiral CT small intestine radiography scanning， 224 cases were diagnosed with small intestine diseases， consistent with that of clinical diagnosis， 56 cases were negative by the 256-slice spiral CT small intestine radiography scanning， and 40 cases met the results， 11 cases were misdiagnosed and 5 cases were missed diagnosis， and the sensitivity， accurate rate， positive predictive value and negative predictive value were respectively 93.8%（244/260）， 94.7%（284/300）， 100% and 71.4%. Conclusion 256-slice spiral CT small intestine radiography scanning technique in diagnosis of small intestine diseases， inflammation and obstruction has the feature manifestations， which is of important significance to the diagnosis and treatment of small intestine diseases， and the clinical promotion value is very good.

[Key words] 256-slice spiral CT small intestine radiography scanning； Small intestine diseases； Clinical diagnosis； Feature manifestations

小肠是机体消化系统的重要组成部分，病变类型较多，如小肠癌、小肠息肉、小肠淋巴瘤等。因小肠独特的生理解剖特点，迂曲冗长、相互重叠、不断蠕动，至今仍是临床和放射学诊断的难点。临床诊断小肠疾病常用X线钡餐、内窥镜等，X线钡餐造影应用造影剂后会遮挡小肠壁黏膜，导致病灶检出和小肠浸润深度的诊断受到影响。内窥镜检查会给患者带来不同程度的痛苦，且存在禁忌症。小肠镜、胶囊内镜对小肠疾病的诊断具有重要意义，但存在一定的局限性。256层螺旋CT小肠造影扫描采用口服大剂量20%甘露醇溶液，对扩张肠管进行小肠造影扫描，通过冠矢状位及血管MIP重建后处理技术实现对小肠肠壁和小肠系膜血管的显示[1]。……