Morris J, Stellato T A, Lieberman J, Haaga J R
Ann Surg. 1986 Aug;204(2):128-32. doi: 10.1097/00000658-198608000-00005.
Forty-one patients admitted to our hospital during an 18-month period with the clinical diagnosis of colonic diverticulitis were analyzed to evaluate the utility of computed tomography (CT). Abdominal pain and leukocytosis were the most common presenting manifestations, 75 and 66%, respectively. Just over one-half of the patients also demonstrated hematuria. Twenty patients required surgical intervention, most commonly for failure to improve despite medical management. Preoperative studies included 10 sigmoidoscopies, 30 plain abdominal roentgenograms, 20 barium enemas (BE), and 24 CT scans. Two CT scans were also obtained after operation for successful percutaneous drainage of intra-abdominal abscesses. Abdominal roentgenograms were most commonly obtained but least helpful, with only one third demonstrating any abnormality whatsoever. Sigmoidoscopy was least commonly performed but almost universally abnormal. Specificity was low, however, in that spasm with inability to advance the endoscope was the most common finding. Of the 20 barium enemas obtained, 60% had findings consistent with diverticulitis, most commonly localized perforation or fixed narrow segment. Sixty-three per cent of CT scans were abnormal. The most frequent findings were localized thickening of the colonic wall and increased density in the pericolic fat. Diverticular abscess, which may be inferred by other studies, was definitely diagnosed in one third of the patients with abnormal CT scans. CT also provided the ability to identify extracolonic intra-abdominal pathology. The study demonstrates that both barium enema and CT are effective in diagnosing diverticulitis, although CT can be performed without risk. CT played no therapeutic role before operation, although two patients benefited after operation by CT-guided drainage of intra-abdominal abscesses. The decision for surgery was most frequently dependent on clinical examination and never solely on the basis of either the barium enema or CT in this study. The major benefit of CT appears to be its ability to identify both gross and subtle changes indicative of diverticular disease and extracolonic pathology in a relatively noninvasive manner.
对我院在18个月期间收治的41例临床诊断为结肠憩室炎的患者进行分析，以评估计算机断层扫描（CT）的效用。腹痛和白细胞增多是最常见的临床表现，分别占75%和66%。略超过一半的患者还出现血尿。20例患者需要手术干预，最常见的原因是尽管进行了药物治疗但病情仍未改善。术前检查包括10次乙状结肠镜检查、30次腹部平片、20次钡剂灌肠（BE）和24次CT扫描。术后还进行了2次CT扫描，用于成功经皮引流腹腔脓肿。腹部平片是最常进行的检查，但帮助最小，只有三分之一显示有任何异常。乙状结肠镜检查是最不常进行的，但几乎普遍异常。然而，其特异性较低，因为内镜无法推进时的痉挛是最常见的发现。在进行的20次钡剂灌肠中，60%的检查结果与憩室炎相符，最常见的是局限性穿孔或固定狭窄段。63%的CT扫描异常。最常见的发现是结肠壁局限性增厚和结肠周围脂肪密度增加。三分之一CT扫描异常的患者被明确诊断为憩室脓肿，其他检查可能只能推断出该情况。CT还能够识别结肠外腹腔病变。该研究表明，钡剂灌肠和CT在诊断憩室炎方面均有效，尽管CT检查无风险。CT在术前未发挥治疗作用，尽管有2例患者术后通过CT引导下引流腹腔脓肿而获益。在本研究中，手术决策最常依赖于临床检查，而从不单纯基于钡剂灌肠或CT结果。CT的主要优势似乎在于其能够以相对无创的方式识别表明憩室疾病和结肠外病变的明显和细微变化。
