肠梗阻的CT诊疗策略培训课件

1、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肠梗阻的CT诊疗策略10/3/20221目 的书写报告不够规范肠梗阻的CT诊疗策略10/3/2022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，甚至死亡肠梗阻的CT诊疗策略10/3/20222何谓肠梗阻 ？由不同原因引起的一组临床症候群，特点是肠内容物准确的诊断刻不容缓 ！肠梗阻的CT诊疗策略10/3/20223准确的诊断刻不容缓 ！肠梗阻的CT诊疗策略10/3/2022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：

2、 肠系膜血管栓塞或 血栓形成病因分类诊断思路 之所在！肠梗阻的CT诊疗策略10/3/20224动力性: 麻痹性、痉挛性机械性: 肠壁病变、肠诊断的 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肠梗阻的CT诊疗策略10/3/20225诊断的 关键！单纯性：无血液循环障碍缺血性（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肠梗阻的CT诊疗策略10/3/20226影像医师的任务判断梗阻的部位及范围肠梗阻的CT诊疗策略10/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肠梗阻的CT诊

3、疗策略10/3/20227Diagnosis of SBO移行带远端肠管萎陷寻找移行带判断肠管是否异常的标准Caliber of small bowel: 外径2.5cmBowel wall thickness：厚度 3mmAbnormal Enhancement ：superior or inferior to the adjacent bowel wall 强化异常 这是我们诊断 的重要依据！肠梗阻的CT诊疗策略10/3/20228判断肠管是否异常的标准Caliber of small bo机械性肠梗阻肠梗阻的CT诊疗策略10/3/20229机械性肠梗阻肠梗阻的CT诊疗策略10/3/202

4、29粘连性肠梗阻Adhesive SBO 最常见！但诊断不易！肠梗阻的CT诊疗策略10/3/202210粘连性肠梗阻Adhesive SBO 最常见！但诊断WW 300 WL 0-10 易于显示粘连带粘连带是诊断的主要依据！肠梗阻的CT诊疗策略10/3/202211WW 300 WL 0-10 易于显示粘连带粘连带是诊断的主移行段和粘连带肠梗阻的CT诊疗策略10/3/202212移行段和粘连带肠梗阻的CT诊疗策略10/3/202212“Feces sign”提示移行段就在附近！肠梗阻的CT诊疗策略10/3/202213“Feces sign”提示移行段就在附近！肠梗阻的CT诊疗“Fat not

5、ch sign” 提示梗阻点所在肠梗阻的CT诊疗策略10/3/202214“Fat notch sign” 提示梗阻点所在肠梗阻的CT“Fat notch sign”是粘连性肠梗阻的一个重要征象肠梗阻的CT诊疗策略10/3/202215“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梗阻的CT诊疗策略10/3/202216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肠套叠成人的肠套叠一般都有其诱因！肠梗阻的CT诊疗策略10/3/202217肠套叠成人的肠套叠一般都有其诱因！肠梗阻的CT诊疗策略10/Subm

6、ucosal lipoma associated with small bowel intussusception肠梗阻的CT诊疗策略10/3/202218Submucosal lipoma associated肠梗粘膜下脂肪瘤看到肠系膜及其血管是诊断的关键！肠梗阻的CT诊疗策略10/3/202219粘膜下脂肪瘤看到肠系膜及其血管是诊断的关键！肠梗阻的CT诊疗A 54-year-old male complained of abdominal pain for 2 monthsGIST肠梗阻的CT诊疗策略10/3/202220A 54-year-old male complained Smal

7、l bowel intussusception肠梗阻的CT诊疗策略10/3/202221Small bowel intussusception肠梗阻Small bowel intussusception 肠系膜及血管 是诊断的关键！肠梗阻的CT诊疗策略10/3/202222Small bowel intussusception 腹 内 疝 常需急诊手术，诊断须及时！肠梗阻的CT诊疗策略10/3/202223腹 内 疝 常需急诊手术，诊断须及时！肠梗阻的CT诊疗策略1Foramen of Winslow hernia in a 43-year-old male with acute epigas

8、tric pain of 10 hours duration. 肠梗阻的CT诊疗策略10/3/202224Foramen of Winslow hernia in aParacolic internal hernia Strangulating SBO3个月前肠梗阻的CT诊疗策略10/3/202225Paracolic internal hernia StraCongested mesenteric vesselsStrangulating SBO due to internal hernia肠系膜积液肠梗阻的CT诊疗策略10/3/202226Congested mesenteric vess

9、elsSt 男，71岁，腹胀、腹痛3天肠梗阻的CT诊疗策略10/3/202227 男，71岁，腹胀、腹痛3天肠梗阻的CT诊疗策略10/3/2诊断要点局限性肠管扩张肠系膜模糊肠系膜血管扩张肠梗阻的CT诊疗策略10/3/202228诊断要点局限性肠管扩张肠梗阻的CT诊疗策略10/3/2022肠道异物Foreign bodies 肠梗阻的CT诊疗策略10/3/202229肠道异物Foreign bodies 肠梗阻的CT诊疗策1年前女，76岁，上腹痛3天肠梗阻的CT诊疗策略10/3/2022301年前女，76岁，上腹痛3天肠梗阻的CT诊疗策略10/3/2不同的窗宽窗位对异物的显示效果diospyro

10、bezoar柿石肠梗阻的CT诊疗策略10/3/202231不同的窗宽窗位对异物的显示效果diospyrobezoar柿A 16-year-old female presented with abdominal pain and distention for 5 daysdiospyrobezoar柿石肠梗阻的CT诊疗策略10/3/202232A 16-year-old female presentedBezoar胃石 肠梗阻的CT诊疗策略10/3/202233Bezoar胃石 肠梗阻的CT诊疗策略10/3/202233Feces sign与Feces sign表现不同肠梗阻的CT诊疗策略10/

11、3/202234Feces sign与Feces sign表现不同肠梗阻的C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，混杂的密度肠梗阻的CT诊疗策略10/3/202235肠道异物诊断要点必须调整合适的窗宽及窗位肠梗阻的CT诊疗策略闭绊性肠梗阻Closed-loop SBO临床需要采取更主动的处理措施！肠梗阻的CT诊疗策略10/3/202236闭绊性肠梗阻Closed-loop SBO临床需要采取更主Closed-loop obstruction is unique form of mechanical bowel obstruction in which two

12、points of intestine along its course are obstructed at single site. C = closed loop, P = proximal loop, D = distal loop. 肠梗阻的CT诊疗策略10/3/202237Closed-loop obstruction is un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肠梗阻的CT诊疗策略10/3/202238闭袢型肠梗阻 ？一段肠袢两端均受压，如肠扭转肠梗阻的CT诊疗a肠梗阻的CT

13、诊疗策略10/3/202239a肠梗阻的CT诊疗策略10/3/202239b肠梗阻的CT诊疗策略10/3/202240b肠梗阻的CT诊疗策略10/3/202240“涡旋征”和“喙征”是肠扭转的典型征象Whirl signBeak sign肠梗阻的CT诊疗策略10/3/202241“涡旋征”和“喙征”是肠扭转的典型征象Whirl signB另一种“喙征”Beak sign肠梗阻的CT诊疗策略10/3/202242另一种“喙征”Beak sign肠梗阻的CT诊疗策略10/3“U”型肠绊肠梗阻的CT诊疗策略10/3/202243“U”型肠绊肠梗阻的CT诊疗策略10/3/202243“C”型肠绊肠梗阻

14、的CT诊疗策略10/3/202244“C”型肠绊肠梗阻的CT诊疗策略10/3/202244相对对称的肠管扩张和狭窄段肠梗阻的CT诊疗策略10/3/202245相对对称的肠管扩张和狭窄段肠梗阻的CT诊疗策略10/3/20绞榨性肠梗阻Strangulating SBO 需要马上做出准确的诊断及手术处理肠梗阻的CT诊疗策略10/3/202246绞榨性肠梗阻Strangulating SBO 需要马上做 Strangulating SBOA mechanical obstruction associated with bowel ischemia，most often associated with

15、closed-loop SBO 机械性肠梗阻+肠管缺血肠梗阻的CT诊疗策略10/3/202247 Strangulating SBOA mechaniAcute bowel ischemia 急性肠缺血肠梗阻的CT诊疗策略10/3/202248Acute bowel ischemia 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

16、 fat stranding and ascites 肠系膜浸润或积液肠梗阻的CT诊疗策略10/3/202249Characteristic findings Bowel 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 vas

17、cular engorgement 肠系膜血管充血肠梗阻的CT诊疗策略10/3/202250Indications of ischemia CircumIndications of ischemiaPresence 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 气体肠梗阻的CT诊疗策略10/3/202251Indications of ischemiaPresenc Ind

18、ications of infarctCircumferential bowel-wall thickening: 3mmDiminished 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

19、体肠梗阻的CT诊疗策略10/3/202252 Indications of infarctCircumMuscularis propriasubmucosamucosa“靶征”肠梗阻的CT诊疗策略10/3/202253Muscularis propriasubmucosamucSystemic 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

20、炎肠梗阻的CT诊疗策略10/3/202254Systemic lupus erythematosus wPeritonitis associated with bowel gangrene肠梗阻的CT诊疗策略10/3/202255Peritonitis associated with boSpoke wheel sign轮辐征Small bowel volvulus肠梗阻的CT诊疗策略10/3/202256Spoke wheel sign轮辐征Small bowelCongested mesenteric veinsStrangulating SBO due to internal hernia肠梗阻的CT诊疗策略10/3/202257Congested mesenteric veinsStra血运性肠梗阻急诊时经常被漏诊或误诊！肠梗阻的CT诊疗策略10/3/202258血运性肠梗阻急诊时经常被漏诊或误诊！肠梗阻的CT诊疗策略10Superior mesenteric vein thrombosis肠梗阻的CT诊疗策略10/3/202259Superior mesenteric vein throm肠系膜上动脉血栓形成肠梗阻的CT诊疗策略10/3/202260肠系膜上动脉血栓形成肠梗阻的CT诊疗策略10/3/20226男，40岁，腹痛并肛门停止排气排便4天肠梗阻的CT诊疗