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目的探讨螺旋CT增强多期扫描对实验性闭袢性肠梗阻肠壁缺血的诊断价值。方法新西兰大白兔24只,分为3组,每组8只;取10~15cm长小肠结扎两端成闭袢,同时结扎闭袢肠段的引流静脉;于模型制成后0·5h(A组)、1~2h(B组)和3~5h(C组)行螺旋CT多期扫描。采用盲法对比分析CT表现与肠壁组织病理改变的关系。结果A组7只及B组4只兔闭袢肠壁增强扫描出现持续强化,C组8只的闭袢肠壁均无明显持续强化。CT值测量:在增强前、增强后的动脉期、静脉期和延迟期A组闭胖肠壁的CT值分别为(56·3±4·3)HU,(139·5±17·9)HU,(145·1±12·6)HU和(124·9±10·5)HU;B组分别为(58·8±5·6)HU,(82·5±13·7)HU,(101·0±20·3)HU和(95·0±16·4)HU;C组分别为(62·1±7·8)HU,(63·9±6·6)HU,(59·5±4·40)HU和(59·6±6·9)HU。在平扫时,A组、B组、C组闭袢肠壁之间的CT值差异无统计学意义(P>0·05)。在增强后的同一时期内,无论是在动脉期、静脉期或是延迟期,A组闭袢肠壁的CT值最大,B组次之,C组最小,而且差意有统计学意义(P<0·05)。在平扫、增强后各期内,A组、B组和C组对照肠袢的CT值差异无统计学意义(P>0·05)。与病理组织学对照,肠壁无坏死组出现持续强化征象的发生率(11/13)明显高于肠壁坏死组(1/11)(P<0·05)。结论螺旋CT多期增强扫描可评价肠壁不同时间的缺血,持续强化主要见于肠壁缺血的早期阶段,而已坏死的肠壁在增强各期均无强化。
Objective To investigate the diagnostic value of enhanced multi-phase spiral CT in the diagnosis of intestinal ischemia in experimental closed intestinal obstruction. Methods Twenty-four New Zealand white rabbits were divided into 3 groups with 8 rats in each group. Ligated 10 ~ 15 cm long intestine was used to ligate both ends of the intestine and ligate the drainage veins of closed intestine. Group), 1 ~ 2h (group B) and 3 ~ 5h (group C) spiral CT multi-phase scan. The relationship between the CT findings and pathological changes of intestinal tissue was analyzed by blinded method. Results Seven rabbits in group A and 4 rabbits in group B showed persistent enhancement of bowel wall enhancement scanning. There was no obvious enhancement of the bowel wall in 8 rabbits in group C. Before CT enhancement, CT values of obstructive intestinal wall in group A were (56.3 ± 4.3) HU and (139.5 ± 17.9) HU respectively before enhancement, in arterial phase, venous phase and delayed phase in group A, HU, (145 · 1 ± 12 · 6) HU and (124 · 9 ± 10 · 5) HU in group B, and HU in group B were (58 · 8 ± 5 · 6) HU and (82 · 5 ± 13 · 7) (101 · 0 ± 20 · 3) HU and (95 · 0 ± 16 · 4) HU, respectively; group C was (62 · 1 ± 7 · 8) HU, (63 · 9 ± 6 · 6) HU, · 5 ± 4 · 40) HU and (59 · 6 ± 6 · 9) HU. There was no significant difference in the value of CT between group A, group B and group C during the plain scan (P> 0.05). During the same period after augmentation, the CT value of the intestinal wall in group A was the largest, the group B was the second, the group C was the smallest, and the difference was statistically significant whether in the arterial phase, venous phase or delayed phase (P <0 · 05). There was no significant difference in CT value between groups A, B and C (P> 0.05). Compared with histopathology, the incidence of persistent enhancement in the non-necrotic group (11/13) was significantly higher than that in the intestinal necrosis group (1/11) (P <0.05). Conclusion Spiral CT multi-phase enhanced scans can evaluate the ischemia of the intestinal wall at different times. The persistent enhancement mainly occurs in the early stage of intestinal ischemia, while the necrotic wall of the intestine has no enhancement in all stages.