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[作者简介]马恩森(1976-),男,山东人,硕士。
研究方向:胸腹影像诊断。
E 2mail :maens @[通讯作者]杨志刚,四川大学华西医院放射科,610041。
E 2mail :cjr.yangzhigang @[收稿日期]2005207211 [修回日期]2005207229CT m anifestation of mesenteric lesions and the anatomic 2pathologic basisM A En 2sen ,YA N G Zhi 2gang3(Department of Radiolog y ,West China Hos pital of S ichuan Universit y ,Cheng du 610041,China )[Abstract] Mesentery is one of the important structure of peritoneal cavity ,which includes mesentery of small intestine ,transverse mesocolon and sigmoid mesocolon.The recognition of CT manifestations of normal anatomy and pathology of mesentery is helpf ul to the correct diagnosis of abdominal diseases such as inflammatory ,cyst ,tumor ,vascular ,trauma and other diseases.[K ey w ords] Mesentery ;Anatomy ;Pathology ;Tomography ,X 2ray computed肠系膜病变的CT 表现及其解剖、病理学基础马恩森综述,杨志刚3审校(四川大学华西医院放射科,四川成都 610041)[摘 要] 肠系膜为腹腔内的重要结构,包括小肠系膜、横结肠系膜、乙状结肠系膜等;正确认识其正常解剖和病变的CT表现,包括炎性病变、囊肿和肿瘤性病变、血管性病变、外伤性病变及其他少见病变等,有助于正确诊断腹部疾病。
[关键词] 肠系膜;解剖学;病理学;体层摄影术,X 线计算机[中图分类号] R657.2;R814.42 [文献标识码] A [文章编号] 100323289(2006)0120155204 肠系膜为腹腔内的重要结构之一,是由双层腹膜形成的皱襞,将肠管悬吊在腹后壁,并使其保持有一定的活动性,它包括小肠系膜、横结肠系膜、乙状结肠系膜等。
肠系膜一方面为腹腔内器官病变(炎性、肿瘤等)扩散提供了一个桥梁,另一方面对腹腔的积液、脓肿起分隔作用。
此外,由于肠系膜内有血管、脂肪、神经、淋巴等组织,可发生原发或继发病变。
在临床影像诊断中,认识肠系膜的正常解剖及病变的影像表现,有助于理解和正确诊断腹部病变的局部表现和扩散,为临床疾病的诊断、治疗及预后判断提供完整的影像学信息。
1 肠系膜正常解剖1.1小肠系膜 指空、回肠的系膜,其整体为褶扇形的结构,一端附着于腹后壁为肠系膜根部,长约15cm,其近端由十二指肠空肠曲开始(相当于第二腰椎左侧)斜向右下,跨十二指肠下部、腹主动脉、下腔静脉、右输尿管和右腰大肌前面,最后止于右骶髂关节上部;另一端与肠管相连,跟空回肠长度一致,约6m,此外,随着肠管的延长与弯曲肠系膜形成许多皱褶,在小肠系膜与肠管相连的肠缘处,两层腹膜分开包绕肠管成为脏腹膜,而在系膜根部,右层下部返折到腹后壁及升结肠,上部连于横结肠系膜下层,左层连于腹后壁及降结肠。
两层腹膜间有肠系膜上血管空、回肠支及伴行的淋巴管、淋巴结、神经丛以及结缔组织和脂肪等组织[1]。
1.2横结肠系膜 将横结肠连于腹后壁的较宽阔的腹膜皱襞,固定腹后壁处称为横结肠系膜根,其两层腹膜从胰头和胰体前方分开包绕横结肠,上层连于大网膜,下层覆盖胰腺下面,并向十二指肠水平部和升部前面延伸,从右向左跨过十二指肠降段和胰头,向胰体、尾部的前下缘延续,并终于膈结肠韧带和脾肾韧带;在胰腺钩突附近和小肠系膜融合在一起,两层腹膜间有中结肠血管,左右结肠血管分支及淋巴结和神经等组织[1,2]。
1.3乙状结肠系膜 是将乙状结肠悬吊于盆壁的腹膜皱襞,附着部即乙状结肠系膜根部,呈倒“V”字形,其尖部近于左髂总动脉分叉处,左层沿腰大肌内侧下行,右层进入骨盆,于中线处止于第三骶椎平面,乙状结肠系膜内含乙状结肠和直肠上血管、淋巴管、神经及脂肪等组织。
系膜根尖后方常可见左输尿管进入盆腔[1]。
2 肠系膜的正常CT表现 在正常情况下,腹膜及其构成的韧带、系膜在普通CT上不易清晰显示,但是由于系膜内含有脂肪、淋巴结、血管等结构,故可以通过调节窗宽、窗位较清楚地显示这些结构,表现为相应部位的脂肪密度内夹杂血管影或小的淋巴结。