目的 分析肠壁囊样积气症(PCI)的多层螺旋CT(multisliecs helieal CT,MSCT)表现特点,以提高本病的诊断水平。方法 回顾性分析北京市石景山医院2008-01至2020-01收治的21例PCI患者的临床和MSCT检查资料,总结其MSCT影像学特征及临床诊断经验及教训。结果 21例PCI中,7例腹胀不适、间断隐痛且自行缓解,2例恶心呕吐,8例停止排便排气,肠镜及碎石后腹痛各2例。病变位于小肠5例,升结肠及盲肠4例,升结肠及横结肠3例,横结肠2例,乙状结肠7例,伴有腹腔游离气体13例,1例伴有肠系膜上静脉、脾静脉、门静脉积气。CT征象呈沿肠曲轮廓分布的黏膜和(或)浆膜下单发气泡影或多发“簇状”“串珠样”“环状”“条带状”含气低密度影,部分见肠内容物悬于肠道中央、见肠壁分层征。伴游离气体患者腹腔脂肪间隙见多发点状、片状气体影。21例中MSCT正确诊断7例,均经非手术治疗后治愈。结论 PCI在MSCT检查中具有一定的特征性表现,结合多平面重建、窗宽窗位技术使用能明确诊断并能显示周围组织情况,为临床治疗提供了重要依据。

Objective To analyze the MSCT characteristics of patients with pneumatosis cystoides intestinalis (PCI) in order to advance our understanding of the disease.Methods The clinical and MSCT examination data of 21 patients with PCI admitted to Beijing Shijingshan Hospital between January 2008 and January 2020 was analyzed retrospectively,while the imaging features of MSCT,experience and lessons from clinical diagnosis were summarized.Results Among the 21 cases of PCI,there was abdominal distension discomfort,intermittent dull pain and spontaneous relief in 7 cases,nausea and vomiting in 2 cases,stop of defecation and exhaust in 8 cases,and abdominal pain after colonoscopy and lithotripsy in 2 cases.The lesions were located in small intestines in 5 cases,in the ascending colon and cecum in 4 cases,in the ascending colon and transverse colon in 3 cases,in the transverse colon in 2 cases,in the sigmoid colon in 7 cases.PCI was accompanied by free abdominal gas in 13 cases,and by superior mesenteric vein,spleen vein and portal vein pneumatosis in 1 case.MSCT showed single empty bubbles and multiple “clustered”“beaded”“annular” and “banded” low density gas shadows along the intestinal curved contour submucosa and/or subserosal.Intestinal contents were located in the center of the intestine,and partial signs of intestinal wall stratification were found.Multiple spot and flaky gas shadows were observed in the fat space of the abdomen of patients with free gas.Of the 21 cases,7 cases were definitely diagnosed by MSCT and were cured with conservative non-surgical treatment.Conclusions PCI has some specific features in the examination of MSCT.The combination of multiplanar reconstruction (MPR) with window-width and window-position technique can facilitate diagnosis and show conditions of the surrounding tissues,providing important clues for clinical treatment.