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结肠神经节缺乏症的临床和多层螺旋CT诊断

李晓阳 田立斌

李晓阳, 田立斌. 结肠神经节缺乏症的临床和多层螺旋CT诊断[J]. CT理论与应用研究, 2023, 32(4): 553-558. DOI: 10.15953/j.ctta.2022.161
引用本文: 李晓阳, 田立斌. 结肠神经节缺乏症的临床和多层螺旋CT诊断[J]. CT理论与应用研究, 2023, 32(4): 553-558. DOI: 10.15953/j.ctta.2022.161
LI X Y, TIAN L B. Clinical and Multilayer Spiral CT Diagnosis of Colon Innervation Defect[J]. CT Theory and Applications, 2023, 32(4): 553-558. DOI: 10.15953/j.ctta.2022.161. (in Chinese)
Citation: LI X Y, TIAN L B. Clinical and Multilayer Spiral CT Diagnosis of Colon Innervation Defect[J]. CT Theory and Applications, 2023, 32(4): 553-558. DOI: 10.15953/j.ctta.2022.161. (in Chinese)

结肠神经节缺乏症的临床和多层螺旋CT诊断

doi: 10.15953/j.ctta.2022.161
详细信息
    作者简介:

    李晓阳:男,河北省唐山市人民医院主任医师、科主任,主要从事肿瘤影像诊断以及脏器功能影像学,E-mail:13315512960@163.com

    通讯作者:

    男,河北省唐山市人民医院主任医师、科主任,主要从事肿瘤影像诊断以及脏器功能影像学,E-mail:13315512960@163.com

  • 中图分类号: R  814

Clinical and Multilayer Spiral CT Diagnosis of Colon Innervation Defect

  • 摘要: 目的:分析结肠神经节缺乏症的多层螺旋CT(MSCT)的影像和临床表现,提高对结肠神经节缺乏症认识。方法:回顾性分析经手术病理证实的结肠神经节缺乏症患者临床以及MSCT影像资料。检查设备采用GE Discovery 750 HD宝石能谱CT和Philips Brilliance Ingenuity 128层多层螺旋,层厚1 mm,层间距1 mm,管电压120 kV,自动管电流,扫描范围自膈顶扫描至双侧耻骨联合下缘。在肠道自然状态下CT扫描(不做肠道准备,即不清洁灌肠和洗肠),扫描后在CT工作站进行MPR三维重建,在PACS系统存档分析。观察MSCT病变段肠管位置,分别测量扩张段和狭窄段肠壁厚度;对病理标本测量狭窄段(病变段)肠管长度;通过多期MSCT观察肠道蠕动情况;通过增强观察肠道血运情况;总结结肠神经节缺乏症患者的临床特征性表现。结果:结肠神经节缺乏症的临床特点表现为成年人长期的便秘和不完全性肠梗阻。本组5例成人结肠神经节缺乏症患者,病变部位分别位于结肠脾曲和降结肠,其中病变段为狭窄段肠管,扩张段结肠为次生继发性改变,病变段肠管位于降结肠3例,位于结肠脾曲2例;MSCT表现为病变段结肠相对狭窄和病变近端结肠扩张,影像特征表现为结肠扩张后狭窄;测量扩张段和狭窄段肠壁厚度:狭窄段病变区肠壁厚度正常,扩张段肠壁厚度正常或有所增厚,本组增厚的肠壁厚度小于0.9 cm;测量病变段肠管长度:本组病变段肠管长度介于4.3~8.6 cm之间;观察结肠血供和肠道功能情况:MSCT增强扫描肠系膜血管以及系膜密度均未见异常改变、病变段结肠肠壁无异常强化,提示扩张与狭窄段结肠血供正常;MSCT三期增强扫描显示病变段肠管僵直、无蠕动,提示病变段肠管蠕动功能丧失。结论:结肠神经节缺乏症具有结肠扩张后狭窄特征性的影像学表现和临床特点,MSCT结合临床资料能够在术前提示结肠神经节缺乏症的诊断。

     

  • 图  1  上腹CT平扫,横结肠脾曲肠腔扩张内径7 cm,肠壁均一弥漫性增厚,厚约0.5 cm,扩张肠腔内大量粪便集聚;结肠脾曲肠腔相对狭窄(空白箭),肠壁厚0.4~0.6 cm

    Figure  1.  CT image of the abdomen,The splenic flexure of colon intestinal lumen was dilated, with an internal diameter of 6 cm, and the intestinal wall was diffuse and thickened, about 0.5 cm thick, and a large number of feces were concentrated in the dilated intestinal lumen. Colonic spleen curved intestinal lumen is relatively narrow (blank arrow), and the intestinal wall is 0.4~0.6 cm thick

    图  2  上腹CT平扫,横结肠肠腔扩张,大部分肠壁厚度正常、局部肠壁轻微增厚,最厚约0.4 cm,扩张的肠腔内大量粪便;降结肠病变段肠管相对狭窄(空白箭),肠壁厚约0.8 cm

    Figure  2.  CT image of the abdomen,The transverse colon lumen is dilated, with uneven thickening, the thickest intestinal wall diameter is about 0.4 cm, a large number of fees were concentrated in the dilated intestinallumen. The diseased segment of the descending colon is relatively narrow (blank arrow), the local thickness is about 0.8 cm

    图  3  图2同一患者,斜冠状位重建图像,降结肠相对狭窄(粗黑箭)、横结肠显著扩张(细黑箭)和小肠扩张(白箭)

    Figure  3.  In the same patient as in fig.2, the descending colon lumen was relatively narrow and the transverse colon lumen was significantly dilated

    图  4  图1患者术后大体标本,肉眼所见:全结肠切除标本:结肠长68 cm,周径5~12 cm,回肠长7 cm,周径3 cm。扩张段肠管长15 cm,周径12 cm,壁厚0.5 cm,粘膜灰红色,质软,皱襞较清晰;狭窄段肠管,长5 cm,周径5 cm,壁厚0.5 cm

    Figure  4.  The Patient of fig.1, postoperative gross specimen, as seen by the naked eye. Total colon resection specimen: The colon is 68 cm long, the peripheral diameter is 5~12 cm, The ileum was 7 cm long with a circumference diameter of 3 cm. The intestine of the dilated segment was 15 cm long, Peridiameter 12 cm, wall thickness 0.5 cm, Mucosal membrane is grey-red, soft, The wrinkles are clear; The arrow segment intestine, 5 cm long, The circumference diameter is 5 cm and the wall thickness is 0.5 cm

    图  5  图1同一患者,HE染色10×10结合免疫组化S-100,显示狭窄段肠黏膜下层及肌间神经节细胞数量显著减少。病理诊断:结肠神经节缺乏症(结肠假性)

    Figure  5.  The same patient of fig.1, HE pathological staining, 10×10 combined with immunohistochemistry S-100, a narrow segment of the intestinal mucosa is shown the number of lower and myomuscular ganglion cells was significantly reduced. Pathological diagnosis: Colonic innervation defect (Hirschsprung' Disease)

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出版历程
  • 收稿日期:  2022-08-07
  • 修回日期:  2022-10-29
  • 录用日期:  2022-11-08
  • 网络出版日期:  2023-01-03
  • 刊出日期:  2023-07-31

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