腸阻塞之電腦斷層的評估

電腦斷層掃描對於腸道阻塞提供了相當多的資訊，包括阻塞的位置，原因和腸腔外的侵犯。本文從1991年7月到1994年2月共蒐集了17個作過電腦斷層掃描且經手術證實腸道阻塞的病例。其電腦斷層影像上的發現及診斷包括(1)擴張的腸腔，小腸直徑＞3cm以上者有83%；大腸直徑＞5cm以上者有80%。(2)阻塞前後之腸腔不成比例，在阻塞處近端的腸腔擴張而遠端呈現萎縮或正常的腸腔（有13例）。(3)在阻塞的位置可見腸腔移行區的變化；若為突然的改變，則需考慮實質物的阻塞，如腫瘤、膽石阻塞或外來物，若是漸漸的變窄或移行區不明顯，可考慮給予口服的對比劑，若能加上臨床的病史，腸沾黏的可能性將大大提高。(4)若大小腸皆均勻的擴張而沒有明顯的狹窄或阻塞的病灶，同時見到可造成腸刺激之出血、腹水或腹膜炎之發炎現象，則考慮麻痺性腸阻塞（有2例）。所以當遇到複雜或不確切原因造成的腸阻塞時，電腦斷層不失爲一重要的診斷工具。

關鍵字

腸，電腦斷層；腸，疾病；腸，狹窄或阻塞

並列摘要

Computed tomography (CT) may offer valuable information about intestinal obstruction, including location, nature and extraluminal invasion. We collected seventeen cases of clinically suspected intestinal obstruction were collected from July 1991 to Feb 1994. All had had CT scan, with diagnosis proved by subsequent surgery. The image findings included (1) Diameter of small bowel ＞3 cm: 83%; diameter of large bowel＞5 cm: 80%; (2) Dilatation in the proximal end and collapse or normal caliber lumen from the distal end to obstructive site (13 cases). (3) Transitional zone: usually abrupt change by organic lesion, if gradual tapering or there was difficult identifying the transitional zone, repeated study with more oral contrast medium and correlation with clinical history may raise the possibility of an adhesion band; (4) paralytic ileus was suspected by diffuse dilatation of both small and large bowel without obvious stenosis or obstructive lesion associated with internal bleeding, ascites or peritonitis on the same time (2 cases). This experiences confirmed that CT is a good tool for the diagnosis of intestinal obstruction and should be done without delay when determination of the obstructive level and cause may necessiate a change of treatment and affect clinical outcome.

並列關鍵字

intestines, CT ； intestines, disease ； intestines, stenosis or obstruction

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腸阻塞之電腦斷層的評估

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