肠梗阻的CT诊疗策略培训.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,目 的,书写报告不够规范,描述不够全面,诊断不够深刻,无法提供准确的资讯,何谓肠梗阻？,由不同原因引起的一组临床症候群，特点是,肠内容物不能顺利通过肠道,，从而引起一系列病理生理变化和临床症状,严重者常致肠管坏死，甚至死亡,准确的诊断刻不容缓！,动力性:麻痹性、痉挛性,机械性:肠壁病变、肠管受压、,肠腔堵塞,血运性：肠系膜血管栓塞或,血栓形成,病因分类,诊断思路 之所在！,诊断的 关键！,单纯性：无血液循环障碍,缺血性（绞榨性）：血液,循环障碍,血液循环是否障碍,影像医师的任务,判断梗阻的部位及范围,判断梗阻的特性,判断肠管是否缺血或坏疽,Diagnosis of SBO,移行带,远端肠管萎陷,寻找,移行带,是诊断的首要任务！,近端肠管扩张,外径2.5cm,判断肠管是否异常的标准,Caliber of small bowel:,外径2.5cm,Bowel wall thickness：,厚度 3mm,Abnormal Enhancement：superior or inferior to the adjacent bowel wall,强化异常,这是我们诊断 的重要依据,！,机械性肠梗阻,粘连性肠梗阻,Adhesive SBO,最常见！,但诊断不易！,WW 300 WL 0-10 易于显示粘连带,粘连带是诊断的主要依据！,移行段和粘连带,“Feces sign”提示移行段就在附近！,“,Fat notch,sign”,提示梗阻点所在,“Fat notch,sign”,是粘连性肠梗阻的一个重要征象,钡剂造影检查可以清楚地显示移行带位置,常规检查未能显示移行带,肠套叠,成人的肠套叠一般都有其诱因！,Submucosal lipoma associated,with small bowel intussusception,粘膜下脂肪瘤,看到肠系膜及其血管是诊断的关键！,A 54-year-old,male complained of abdominal pain for 2 months,GIST,Small bowel intussusception,Small bowel intussusception,肠系膜及血管,是诊断的关键！,腹 内 疝,常需急诊手术，诊断须及时！,Foramen of Winslow hernia in a 43-year-old male,with acute epigastric pain of 10 hours duration.,Paracolic internal hernia,Strangulating SBO,3个月前,Congested mesenteric vessels,Strangulating SBO due to internal hernia,肠系膜积液,男，71岁，腹胀、腹痛3天,诊断要点,局限性肠管扩张,肠系膜模糊,肠系膜血管扩张,肠道异物,Foreign bodies,1年前,女，76岁，上腹痛3天,不同的窗宽窗位对异物的显示效果,diospyrobezoar柿石,A 16-year-old female presented with,abdominal pain and distention for 5 days,diospyrobezoar柿石,Bezoar胃石,Feces sign,与Feces sign表现不同,肠道异物诊断要点,必须调整合适的窗宽及窗位,清楚的境界，可见假包膜,呈椭圆形，混杂的密度,闭绊性肠梗阻,Closed-loop SBO,临床需要采取更主动的处理措施！,Closed-loop obstruction is unique form of mechanical bowel obstruction,in which two points of intestine along its course are obstructed at,single site.C=closed loop,P=proximal loop,D=distal loop.,闭袢型肠梗阻？,一段肠袢两端均受压，如肠扭转,结肠梗阻时回盲瓣关闭防止逆流，也可以形成闭袢型肠梗阻,容易发生肠坏死和穿孔,影像科医师需要准确做出诊断,a,b,“涡旋征”和“喙征”是肠扭转的典型征象,Whirl sign,Beak sign,另一种“喙征”,Beak sign,“U”型肠绊,“C”型肠绊,相对对称的肠管扩张和狭窄段,绞榨性肠梗阻,Strangulating SBO,需要马上做出准确的诊断及手术处理,Strangulating SBO,A mechanical obstruction associated with bowel ischemia，most often associated with closed-loop SBO,机械性肠梗阻+肠管缺血,Acute bowel ischemia 急性肠缺血,Characteristic findings,Bowel wall thickness,:肠壁厚度,Bowel wall attenuation,:肠壁密度,Dilatation of the bowel lumen：肠管扩张,Mesenteric vessels：肠系膜血管,Mesentery,:mesenteric fat stranding and ascites 肠系膜浸润或积液,Indications of ischemia,Circumferential bowel-wall thickening,肠壁环形增厚,Bowel wall edema,肠壁水肿,Increased attenuation of the bowel wall,肠壁密度增高,Subjective decreased relative enhancement of the bowel wall,肠壁强化减弱,Mesenteric vascular engorgement,肠系膜血管充血,Indications of ischemia,Presence of mesenteric fluid,肠系膜积液,Presence of ascites,腹水,Presence of intramural air,extraalimentary air,portal venous or mesenteric venous air,气体,Indications of infarct,Circumferential bowel-wall thickening:,3mm,Diminished or absent bowel wall enhancement,强化减弱或不强化,Mesenteric vascular engorgement,肠系膜血管充血,Infiltration of the involved mesentery,肠系膜浸润,Free fluid,游离液体,Presence of intramural air,extraalimentary air,portal venous or mesenteric venous air,气体,Muscularis propria,submucosa,mucosa,“靶征”,Systemic lupus erythematosus with mesenteric ischemia,in a 20-year-old man.Target sign,mesenteric vascular,engorgement and haziness are showed on CE-CT scan.,血管炎,Peritonitis associated with bowel gangrene,Spoke wheel sign,轮辐征,Small bowel volvulus,Congested mesenteric veins,Strangulating SBO due to internal hernia,血运性肠梗阻,急诊时经常被漏诊或误诊！,Superior mesenteric vein thrombosis,肠系膜上动脉血栓形成,男，40岁，腹痛并肛门停止排气排便4天,男，58岁，左上腹疼痛1周并血便1天,A 27-year-old male presented with,abdominal pain of 10 hours duration,Target sign,血运性肠梗阻,更多地表现为血管分布区的,肠管管壁增厚，密度增高,，肠腔扩张不明显,血管腔内的,密度改变,，是诊断的关键,总 结,寻找梗阻点是诊断的关键,薄层重建是诊断的必要条件,判断肠道是否缺血是诊断的首要任务,CT对肠梗阻能够进行定位与定性诊断,你做到了吗？,诊断原则,确定是否存在肠梗阻,寻找梗阻点（定位）,判断梗阻类型（单纯性或绞榨性？）,明确可能的病因,足够的耐心和准确的判断力！,Thanks for your attention!,