多层螺旋CT肠道造影在小肠病变中的临床应用

罗海波　李先明　周建辉　余钟建　严敏红

【摘要】 目的：探討多层螺旋CT肠道造影（multislice spiral CT enterography，MSCTE）在小肠病变检查中的临床应用价值。方法：选取本院2015年1月-2016年10月收治的76例疑似小肠疾病患者，所有患者于45 min内分3～4次口服20%的甘露醇溶液+碘佛醇注射液+温开水共2 000 mL；约75 min行全腹部CT平扫和增强扫描，将MSCTE检查结果与CT平扫、手术病理或内窥镜检查进行对比分析，评估MSCTE在小肠肿瘤性病变、小肠炎症性病变等小肠病变中的诊断符合率、敏感性、特异性、阳性预测值和阴性预测值。结果：所有患者均顺利完成CT平扫和MSCTE检查，MSCTE的诊断符合率为94.74%，明显高于CT平扫的47.37%，差异有统计学意义（字2=41.455，P<0.01）；MSCTE的敏感性、特异性、阳性预测值和阴性预测值分别为96.43%、90.00%、90.00%和96.43%均明显高于CT平扫法的65.63%、34.09%、57.69%和42.00%，差异均有统计学意义（P<0.05）。结论：与常规CT平扫相比，MSCTE检查应用于小肠病变诊断中具有更高的诊断符合率、敏感性和特异性，明显提高小肠疾病的诊断能力，在小肠病变检查中值得推荐应用。

【关键词】 多层螺旋CT小肠造影； 小肠疾病； 等渗甘露醇

Clinical Application of Multislice Spiral CT Enterography in Small Intestinal Lesions/LUO Haibo，LI Xianming，ZHOU Jianhui，et al.//Medical Innovation of China，2018，15（12）：055-058

【Abstract】 Objective：To investigate the clinical application value of Orally contrast agent combined with multislice spiral CT enterography in detection of small intestinal lesions.Method：A total of 76 patients with suspected small bowel disease treated in our hospital from January 2015 to October 2016 were selected，20% Mannitol Solution+Iodofol Injection+warm water 2 000 mL were divided into 3-4 times within 45 min to all patients oral administration；the full abdominal CT plain scan and enhanced scan were performed at about 75 min.The MSCTE result was compared with CT plain scan，pathology and endoscopy result，the diagnostic accuracy，sensitivity，specificity，positive predictive value and negative predictive value of MSCTE in small intestinal lesions of small bowel tumor the lesion，intestinal inflammatory lesions were evaluated.Result：All patients successfully completed CT plain scan and MSCTE examination，the diagnostic coincidence rate of MSCTE was 94.74%，which was significantly higher than 47.37% of CT plain scan，the difference was statistically significant（字2=41.455，P<0.01）.The sensitivity， specificity，positive predictive value and negative predictive value of MSCTE were 96.43%，90.00%，90.00% and 96.43%，which were significantly higher than those of CT plain scan（65.63%，34.09%，57.69% and 42.00%），the differences were statistically significant（P<0.05）.Conclusion： Compared with routine CT plain scan，MSCTE has a higher diagnostic coincidence rate，sensitivity and specificity in diagnosis of small intestinal lesions，and it can significantly improve the diagnostic ability of small bowel disease.It is recommended to be applied in the detection of small intestinal lesions.

【Key words】 Multislice spiral CT enterography； Small intestine disease； Isosmotic mannitol

First-authors address：Yuancheng District Peoples Hospital of Heyuan City，Heyuan 517000，China

doi：10.3969/j.issn.1674-4985.2018.12.016

小肠是机体消化食物和营养吸收的主要场所，但是由于小肠走形弯曲、重叠度大且结构非常复杂，是多种疾病的好发部位[1-2]。临床常见的小肠疾病包括小肠炎症性病变、小肠肿瘤、小肠血管性病变、小肠功能性疾病以及全身性疾病小肠受累的病变[3]。以往临床对小肠病变的检查多以插管钡灌肠及小肠镜为主，但是由于假阴性率高、操作复杂和患者不易接受等劣势而不利于临床推广[4]。多层螺旋CT是近年来发展起来的新的诊断方式，能够快速、全景式对小肠多个部位进行扫描，并且还具有后处理功能，目前已有临床工作者将其应用于小肠病变的诊断中[5-6]。在本研究中，笔者就口服造影剂多层螺旋CT肠道造影（Multislice spiral CT Enterography，MSCTE）在小肠病变中的临床应用价值进行了探讨，结果令人满意，现报道如下。……