| Objective:(1)To investigate the clinical manifestations and MSCT findings of intestinal obstruction patients on the assessment of intestinal tract activity.(2)To discuss the diagnostic value of MSCT in the reversible of blood flow disorder in patients with ileus caused by different etiologies.Materials and Methods:376 cases of intestinal obstruction with perfect clinical and imaging data were analyzed retrospectively.All cases were confirmed by clinical,surgical and pathological results.According to the clinical manifestation and operation,the patients were classified into no blood transport disorder group(326 cases)and blood transport disorder group(50 cases).According to the results of operation and pathology,the group of blood transport disorder was divided into reversible dysphagia group(29 cases)and irreversible dysphagia group(21 cases).The clinical data and MSCT findings of different groups of intestinal obstruction were analyzed,and their value in evaluating intestinal wall blood disorder was analyzed.Results:(1)In the clinical manifestations of the patients with intestinal obstruction,the sensitivity and specificity of abdominal rebound pain in blood supply obstruction were higher than other parameters.Mental disorders and blood stool were closely related to blood transport disorder,and the statistical results showed that the difference was statistically significant(P<0.05).(2)The diagnostic accuracy of CT in the diagnosis of no blood disorder group is higher than that of clinical and pathological diagnosis,and the coincidence rate was 93.84%,but the rate of diagnosis was relatively low in the group of blood transport disorders.(3)In patients with pathological results,the time from the patience have symptom to operative,analysis showed that intestinal necrosis accounted for 58.3%for these patients visiting time more than 48h,and intestinal necrosis patients accounted for 26.9%for these patients visiting time is less than 48h.It is suggested that the early diagnosis and treatment after onset of disease,the incidence of irreversible intestinal wall ischemia is lower.(4)In evaluating the signs of intestinal wall hemodynamic disorder in patients with intestinal obstruction,the sensitivity and specificity of intestinal wall thickened,CT scan intestinal wall density reduced and CT enhanced scan of bowel wall enhancement degree decreased,the increase of mesenteric density were higher(P<0.05).The decrease of intestinal wall density,the increase of mesenteric density,the defect of blood vessel filling,the accumulation of gas in intestinal wall and ascites in MSCT findings are of great value in judging the reversibility of intestinal blood flow(P<0.05).Conclusion:(1)The clinical symptoms of intestinal obstruction have certain predictive value in the case of intestinal wall blood transport disorder,especially the occurrence of consciousness disorder and blood stool,and the possibility of irreversible intestinal obstruction is significantly increased.Patients with clinical symptoms of ileus should be treated as early as possible(recommended for 48h)to reduce the risk of irreversible intestinal wall blood disorder.(2)MSCT has important clinical value in the diagnosis of intestinal obstruction,which can not only carry out the diagnosis of causes,but also can preliminarily determine the intestinal activity;especially when the MSCT image appears such signs:the mesenteric vascular filling defect,bowel wall thickening,edema,the enhanced intestinal wall but inhomogeneous enhancement,are reliable signs of the intestinal ischemia;There is a strong sign of necrosis in the intestinal wall of the intestinal wall and the presence of free gas in the abdominal wall.These signs are of important clinical significance for guiding clinical early intervention to improve the prognosis of patients. |
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