目的 探讨腹腔注入空气后CT扫描对判断肝脏位置变化的价值。方法 选择2019-06至2022-06解放军总医院第三医学中心行气腹术后CT扫描患者36例,观察不同体位肝脏位置变化,测量肝脏在不同体位其边缘与腹壁间的距离。结果 36例行气腹造影术后,肝脏位置变化显示清晰,仰卧位:肠粘连组肝脏前缘距离前腹壁平均距离(4.95±1.28)cm,无肠粘连组肝脏前缘距离前腹壁平均距离(4.64±1.11)cm,两组对比,差异无统计学意义(t=0.754,P=0.456)。左斜位:肠粘连组肝脏前缘距离右前腹壁平均距离(5.62±1.05)cm,无肠粘连组肝脏前缘距离右前腹壁平均距离(5.44±0.53)cm,两组间差异无统计学意义(t=0.609,P=0.547)。右斜位:肠粘连组肝脏前缘距离左前腹壁平均距离(5.62±1.50)cm,无肠粘连组肝脏前缘距离左前腹壁平均距离(4.95±0.80)cm,两组间差异无统计学意义(t=1.578,P=0.124)。俯卧位:肠粘连组肝脏后缘距离后腹壁平均距离(4.18±0.89)cm,无肠粘连组肝脏后缘距离后腹壁平均距离(4.03±1.28)cm,两组间差异无统计学意义(t=0.401, P=0.691)。结论 气腹术后CT扫描示:肝脏位置变化明显,距离腹壁间隙较大,四个体位中,其中左斜位、右斜位肝脏移动距离较远。

Objective To implore the value of CT scanning after intraperitoneal air injection in determining the changes of liver position. Methods A total of 36 patients who underwent CT scanning after pneumoperitoneum operation in the Third Medical Center of Chinese PLA General Hospital from June 2019 to June 2022 were selected to observe the changes of liver position in different positions and measure the distance between the liver edge and abdominal wall in different positions. Results After pneumoperitoneography, the liver position of 36 patients showed clear changes. Supine position: the average distance between the leading edge of the liver and the anterior abdominal wall was (4.95±1.28) cm in the intestinal adhesion group and (4.64±1.11) cm in the non-intestinal adhesion group, with no statistical difference between the two groups (t=0.754,P=0.456). Left oblique position: the mean distance between the leading edge of the liver and the right anterior abdominal wall was (5.62±1.05) cm in the intestinal adhesion group and (5.44±0.53) cm in the non-intestinal adhesion group, with no statistical difference between the two groups (t=0.609,P=0.547). Right oblique position: the mean distance between the leading edge of the liver and the left anterior abdominal wall in the intestinal adhesion group was (5.62±1.50) cm, and the mean distance between the leading edge of the liver and the left anterior abdominal wall in the non-intestinal adhesion group was (4.95±0.80) cm, with no statistical difference between the two groups (t=1.578,P=0.124). Prone position: the mean distance between the liver posterior edge and the posterior abdominal wall in the intestinal adhesion group was (4.18±0.89) cm, and the mean distance between the liver posterior edge and the posterior abdominal wall in the non-intestinal adhesion group was (4.03±1.28) cm, with no statistical difference between the two groups (t=0.401,P=0.691). Conclusions After pneumoperitoneum, CT scanning is safe and effective. The position of the liver changes significantly, and the distance from the abdominal wall space becomes larger. In the four positions, the left oblique position and the right oblique position show larger liver movement distance.