回盲部囊肿型肠重复畸形的影像诊治分析

目的：探讨回盲部囊肿型肠重复畸形的影像学特点。方法：回顾性分析经手术证实的6例回盲部囊肿型肠重复畸形的影像学表现及临床特点。结果：6例患儿中4例因急腹症入院检查,术前3例影像学诊断为肠套叠,1例诊断为肠梗阻。主要CT表现为回盲部低密度囊性肿块,可见软组织密度环即双环征。4例合并肠套叠或肠梗阻,3例行气钡灌肠示回盲部软组织块影,仅有部分气体进入小肠,均未能彻底整复。结论：回盲部肠重复畸尤其是肠内囊肿型常常合并急腹症而发病,容易漏诊,CT能够做出正确的诊断,合并有肠套叠时气钡灌肠效果不佳,应及早行手术治疗。     

超声下空气灌肠整复小儿肠套叠的应用价值

目的探讨超声下空气灌肠整复术治疗小儿肠套叠的临床应用价值。方法回顾分析本院37例超声引导下空气灌肠整复小儿肠套叠的影像学资料。所有患儿均先行立位腹透排除膈下游离气体,再行常规超声检查,明确诊断后,直接在超声实时监视下,采用空气灌肠机对患儿进行空气灌肠,整复压力为6~12k Pa。如套头出现停顿不动,则排气后对相应部位的腹部进行揉按。再继续充气并用超声观察,如发现套头迅速消失且大量气体进入小肠,小肠区内见广泛气体强回声,则提示整复成功。结果本组肠套叠患儿均为回—结肠型,横切面上均表现为典型的"同心圆征",所有患儿均成功整复。其中3例患儿整复后出现回盲瓣处水肿,在声像图上可见环形低回声的水肿带,称为"暗环征"。结论超声下空气灌肠整复小儿肠套叠既方便、快捷,又避免了常规X线透视的辐射损害,有望成为小儿肠套叠的首选治疗方法。     

小儿肠套叠的影像学分析

目的 探讨临床影像学诊断方法在婴幼儿肠套叠的应用价值.方法 对临床50例肠套叠患儿行超声及空气灌肠X射线检查.结果 婴幼儿肠套叠临床表现为腹痛、哭闹、呕吐、果酱样血便和腹部包块等.腹部超声检查显示腹腔内"同心圆征"、"套筒征",空气灌肠X射线检查具有诊断和治疗双重功效.结论 临床可疑为肠套叠者宜先行超声筛查,空气灌肠X射线检查整复效果显著.     

空气灌肠复位失败的小儿肠套叠CT表现

目的探讨空气灌肠复位治疗失败的小儿肠套叠CT特点。方法回顾性分析16例肠套叠经空气灌肠复位治疗失败后的CT表现。结果16例中结结型1例,回回型1例,回盲型3例,回结型5例,回回结型6例。CT表现为套叠长度3．O～7．0cm,平均4．2cm;套叠部位呈“肾形”8例,“靶形”5例,“彗尾征”2例,“腊肠样”1例;套鞘肠壁增厚、分层并见气体影6例,腹腔积液3例。结论空气灌肠复位失败的小儿肠套叠CT表现具有特征性,能为临床制定手术方案提供影像依据。     

婴幼儿肠套叠合并阑尾炎X线表现的病理基础及临床意义

目的 探讨婴幼儿肠套叠合并阑尾炎的X线表现及其临床意义。资料与方法对28例经手术病理证实的婴幼儿肠套叠合并阑尾炎的X线表现及临床资料进行回顾性分析。结果 (1)17例回-结型肠套叠中合并急性单纯性阑尾炎13例，化脓性阑尾炎2例；11例复合型肠套叠中合并急性阑尾炎4例，化脓性阑尾炎6例。发现3例合并慢性阑尾炎，炎症为继发再次肠套叠的诱因。(2)主要X线表现：①腹部少气或无气征15例；②右侧腹膜外脂线局部或全部模糊征18例；③右下腹肠腔异常积气和／或小肠梗阻征9例。右侧腹膜外脂线局部或全部模糊征象出现率最高。结论 阑尾炎是婴幼儿肠套叠的最主要早期并发症。X线表现结合临床资料对其发生有重要提示意义，对预防阑尾炎症致继发肠套叠或其他并发症有重要价值，尤其在空气灌肠整复后的治疗上。     

超声对小儿回结型和小肠型肠套叠的鉴别价值

目的 ：分析小儿回结型与小肠型肠套叠的超声表现,提高临床诊断准确率。方法 ：回顾性分析235例肠套叠患儿的临床和超声资料,其中小肠型148例（小肠型组）和回结型87例（回结型组）。结果：2组病变直径、脂肪核厚度、外壁厚度、核-壁指数、套入长度和肠套叠内可见淋巴结比较,差异均有统计学意义（均P<0.001）。在小肠型组中,78.4%(116/148)的正常回盲部位于右下象限,96.6%(143/148)的正常升结肠位于右侧腹;回结型组未发现正常回盲部,仅5例（5.7%）发现正常升结肠,2组上述超声特征差异均有统计学意义（均P<0.001）。结论：超声是鉴别小儿回结型和小肠型肠套叠最实用的方法。正常回盲部和升结肠有助于准确区分肠套叠的类型,提高诊断准确率,指导临床治疗。     

婴幼儿先天性巨结肠的X线诊断

目的：探讨婴幼儿先天性巨结肠的X线诊断要点.方法：收集我院47例经手术及病理证实的先天性巨结肠患儿,分析其腹部立位片及结肠钡剂造影的影像学表现.结果：腹部立位片示低位结肠不全性梗阻35例,肠淤张17例,小肠低住梗阻1例.结肠钡剂造影显示常见型39例,短段型5例,超短段型2例,长段型1例,征象可见痉挛段、移行段及扩张段,其中3例新生儿及超短段型狭窄段显示不明显,3例移行段显示不明显,24 h复查38例有不同程度钡剂残留.结论：凡临床怀疑先天性巨结肠的婴幼儿应尽早行腹部立位片及结肠钡剂造影检查,并随访观察24 h钡剂排空情况,对其早期诊断及治疗有重要意义.     

小儿肠套叠空气灌肠整复的疗效及影响因素

目的：分析肠套叠空气灌肠整复不能复位的影响因素，提高整复成功率及安全性。方法：1997年-2001年间495例肠套叠中443例经空气灌肠整复，52例未整复成功经手术治疗（其中2例整复时穿孔）。整复压力6．5-12．5kPa（48．75-93．75mmHg）。165例肌内注射654-2约5mg。52例中年龄2月至13月，平均5．3月，发病6至70小时，平均32小时，31例超过24小时。结果：52例手术病例，27例有肠坏死；49例为复套，回-回-结型39例，回-盲-结型7例，回-回-盲-结型3例；35例套叠颈部较紧；29例套头大，呈分叶状；7例套入头部有原发病变。结论：89．5％小儿肠套叠可经空气灌肠整复。影响整复的因素有：发病时间；套叠类型；注气压力；解痉药物；整复器类型。     

29例小儿急性肠套叠空气灌肠整复治疗分析

目的：探讨婴幼儿肠套叠空气灌肠整复的疗效。方法：29例肠套叠患儿，在X线透视机下，用CTB201型自动遥控灌肠器行空气灌肠（压力8.0-16.0KPa）进行整复术。结果：29例患者行空气灌肠后均明确诊断，其中20例为回一结肠型肠套叠，5例为结-结肠型，4例为回-回结肠型。结论：空气灌肠是治疗小儿肠套叠首选的安全、方便的方法。灌肠前注射解痉药物效果更佳。     

CT扫描在急性肠梗阻诊断中的应用

目的评价CT扫描对急性肠梗阻的诊断价值。方法对38例急性肠梗阻患者的CT表现进行了回顾分析。38例中的28例是经手术病理证实，包括17例直结肠癌，1例小肠平滑肌瘤，3例肠套叠，2例肠扭转，4例回盲部炎性病变，以及1例粪石性梗阻，另外10例既往有腹部手术史的患者是经临床随访证实为肠粘连。所有患者均经CT平扫和静注对比剂后增强扫描。结果CT扫描显示，直肠结肠癌主要表现为伴有管腔狭窄的软组织肿块，病灶密度不均匀，增强后实质部分强化；小肠平滑肌瘤表现为类圆形软组织肿块，密度均匀，边缘光整，增强后均匀强化；肠套叠可见肠管呈同心圆状改变；肠扭转可见螺旋征；回盲部炎性病变表现为软组织影伴周围渗出性改变，1例误诊为恶性肿瘤；粪石性梗阻缺乏特征性改变，增强后未见强化；CT诊断急性肠梗阻的敏感性，特异性，准确性，阳性预测值及阴性预测值分别为100％、95．2％、93．3％、94．4％、和95．4％。结论CT扫描对急性肠梗阻的定位诊断、病因诊断以及血供情况的了解均具有明显的优势，非常有利于临床治疗方案的制定。     

胆石性肠梗阻的影像学诊断

目的探讨胆石性肠梗阻的影像诊断价值。资料与方法回顾性分析7例经手术或内镜证实的胆石性肠梗阻患者的影像资料及临床表现,影像检查包括立卧位腹部平片7例,消化道碘水造影1例,CT检查6例,MRI检查2例。结果7例患者皆有程度不等的肠梗阻表现。6例CT检查见肠腔内异位结石,7例腹部平片中2例显示肠腔内异位结石,MRI检查的2例均见肠腔内异位结石,1例消化道造影示十二指肠充盈缺损,误为肿瘤性病变。腹部平片2例见胆囊区积气,6例CT见胆囊积气、胆囊窝结构紊乱,其中2例胆囊与十二指肠内气体相通,1例MRI显示胆囊与十二指肠间有高信号液体相通。结论胆石性肠梗阻影像检查中腹部平片除明确肠梗阻外,仔细寻找肠内阳性结石会对诊断有帮助,CT与MRI均能明确诊断,价值相仿。     

Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus

In recent years the increasing use of ultrasonography and computed tomography in the assessment of diseases causing acute abdomen and the diagnostic possibilities of magnetic resonance have decreased the role of conventional radiology techniques, especially of plain abdominal film in the diagnosis of acute abdomen. However, serial plain abdominal film is still the first diagnostic procedure used in the assessment of patients with acute abdominal pain, providing important diagnostic information if correctly performed and carefully observed. In this paper serial plain abdominal film findings related to the different types of ileus (spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus) are presented.     

Gallstone ileus analysis of radiological findings in 27 patients

PURPOSE: We retrospectively compared the clinical value of plain abdominal film, abdominal sonography and abdominal CT in diagnosing gallstone ileus in 27 patients. MATERIAL AND METHODS: 27 patients (23 women and 4 men, age range 58-96 years; mean age 71.5 years) with surgically proven gallstone ileus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain films were performed in 19 cases in upright position (postero-anterior projection), in eight cases in supine position. Abdominal US were performed with 3.5 and/or 7.5 MHz probes. CT was performed with a helical unit (slice thickness 4mm, reconstruction interval 4mm, pitch 1.5), after intravenous contrast agent (120 ml) infusion (3 ml/s, 55 s acquisition delay from bolus starting) and using a power injector. The following findings were searched on: pneumobilia, air in gallbladder, cholecysto-digestive fistula, extraluminal fluid, bowel loops dilatation, intestinal air-fluid levels, ectopic stones. RESULTS: Plain abdominal films showed the following findings: air-fluid levels (77.78% of cases), bowel loops dilatation (88.89%), site of obstruction (44.4%), pneumobilia (37.04%), air in gallbladder (3.70%), ectopic stone (33.33%). Abdominal sonography demonstrated bowel loops dilatation (44.44%), extraluminal fluid (14.81%), ectopic stones (14.81%), gallbladder abnormalities, (37.04%), pneumobilia (55.56%). CT findings retrospectively observed were: bowel loops dilatation (92.59%), air-fluid levels (37.04%), bilio-digestive fistula (14.81%), pneumobilia (88.89%), ectopic stone (81.48%), extraluminal fluid (22.22%). The Rigler's triad, that is pneumobilia, bowel mechanical obstruction and ectopic stone detection was observed 4 times with RX (14.81%), 3 times with US (11.11%) and 21 times with CT (77.78%). CONCLUSIONS: Air-fluid levels and bowel loop dilatation were the radiological findings more frequently observed in our series. Plain abdominal film allowed us mainly to identify signs of obstruction, US were more effective in disclosing biliary pathology, CT allowed us to correctly diagnose biliary ileus with much higher accuracy.     

Personal experience in 71 consecutive patients with acute cholecystitis

PURPOSE: Acute cholecystitis is one of the most frequent abdominal inflammatory processes. If untreated or misdiagnosed it can result in severe complications such as gallbladder rupture, abscesses, or peritonitis. We retrospectively reviewed a series of 71 consecutive patients with surgical confirmation of acute cholecystitis and now compare the results of the diagnostic techniques we used preoperatively. MATERIAL AND METHODS: Over 16 months, 71 consecutive patients (42 women and 29 men; age range: 34-84 years, mean: 58) with acute abdominal pain were operated on for acute cholecystitis at Cardarelli Hospital, Naples. Abdominal plain film was performed in 65 of 71 cases, abdominal US in 69 and abdominal CT in 6. On abdominal plain films, we retrospectively searched the following signs: densities projected over the gallbladder, linear calcifications in gallbladder walls, gallbladder enlargement, focal gas collections within the gallbladder, and air-fluid levels in the gallbladder lumen. On US images we looked for: gallbladder wall thickening (> 3 mm), intraluminal content in the gallbladder, pericholecystic fluid, US Murphy's sign, and gallbladder distension. On CT images, we investigated: gallbladder distension, wall thickening, intraluminal content, pericholecystic fluid, and inflammatory changes in pericholecystic fat. Associated complications of cholecystitis were also searched on all images. RESULTS: On plain abdominal films we found densities projected over the gallbladder (16.9%) and linear calcifications in the gallbladder wall (4.6%). Abdominal US demonstrated gallbladder wall thickening (56.5%), one or more gallstone(s) (85.5%), pericholecystic fluid (14.5%), gallbladder distension (46.4%), and US Murphy's sign (39.1%). Abdominal CT showed gallbladder wall thickening (83.3%), gallbladder distension (66.6%), pericholecystic fluid (66.6%), gallstones (50%), inflammatory changes in pericholecystic fat (33.3%), and increased bile density (> 20 HU) (33.3%). CONCLUSIONS: US appears to be the most useful imaging technique in patients with suspected acute cholecystitis, for both screening and final diagnosis. CT plays a limited role in the early assessment of these patients, but can be a useful tool in diagnosing acute cholecystitis in patients with questionable physical findings or in investigating related complications.     

Plain radiographic examination and abdominal echography in intestinal occlusion syndrome. Preliminary note

Plain film of the abdomen is widely used in the diagnostic evaluation of intestinal occlusion. Even though this technique can yield a panoramic and high-resolution view of gas-filled intestinal loops, several factors, such as type and duration of occlusion, neurovascular status of the intestine and general patient condition, may reduce the diagnostic specificity of the plain film relative to the organic or functional nature of the occlusion. From 1987 to 1989, fifty-four patients with intestinal occlusion were studied combining plain abdominal film with abdominal ultrasound (US). This was done in order to evaluate whether the additional information obtained from US could be of value in better determining the nature of the ileus. US evaluation was guided by the information already obtained from plain film which better demonstrates gas-filled loops. The results show that in all 27 cases of dynamic ileus (intestinal ischemia, acute appendicitis, acute cholecystitis, acute pancreatitis or blunt abdominal trauma) US demonstrates: intestinal loops slightly increased in caliber, with liquid content, or loops containing rare hyperechoic particles, intestinal wall thickening and no peristalsis. In 27 cases of acute, chronic or complicated mechanical ileus (adhesions, internal hernia, intestinal neoplasm, peritoneal seedings) US shows: 1) in acute occlusion: hyperperistaltic intestinal loops containing inhomogeneous liquid; 2) in chronic occlusion: liquid content with a solid echogenic component; 3) in complicated occlusion: liquid stasis, frequent increase in wall thickness, moderate peritoneal effusion and inefficient peristalsis. In conclusion, based on the obtained data, the authors feel that the combination of plain abdominal film and abdominal US can be useful in the work-up of patient with intestinal occlusion. The information provided by US allows a better definition of the nature of the ileus.     

婴儿肠旋转不良影像学检查的探讨

目的:探讨婴儿肠旋转不良影像学检查的价值.方法:回顾性分析41例经手术证实的婴儿肠旋转不良患者的病例资料.所有病例均摄腹部平片,16例行钡剂灌肠,18例行钡餐检查.结果:腹部平片显示十二指肠部分性梗阻32例,双泡征13例,小肠低位梗阻并腹腔积液3例,未见明显异常3例.钡剂灌肠显示阑尾位于右上腹10例,右中腹1例,左上腹4例,1例位置正常;与手术中记录的阑尾位置比较,诊断符合率较低(28.6%,4/14).钡餐检查显示十二指肠水平段及其近端扩张、梗阻,扩张远端呈鼠尾状改变6例,其中2例显示为完全性梗阻;十二指肠空肠曲位置异常11例;十二指肠螺旋型下降13例;空肠位于右侧腹9例,位置正常1例.结论:在肠旋转不良影像学检查中,腹部平片能提供肠道气体的异常信息,可作为本病的首诊检查方法;钡剂灌肠虽然可显示阑尾位置异常,但诊断准确性低,胃肠钡餐检查可显示十二指肠的位置和形态,是确诊本病的较好影像学方法.     

儿童小肠机械性梗阻的CT诊断

目的 探讨CT检查对儿童小肠机械性梗阻的诊断价值。方法 分析31例手术确诊为小肠机械性梗阻患者的腹部X线平片与CT表现。年龄9个月至14岁,男17例,女14例。急性小肠梗阻29例,慢性小肠梗阻2例。其中7例有腹部手术史。结果 腹部X线平片与CT准确显示梗阻程度分别为19例和29例。CT准确显示梗阻病因18例,包括小肠石4例,肠套叠5例,腹腔局部感染渗出粘连6例,腔内型肠重复畸形1例,先天性脐疝1例,先天性肠旋转不良1例。本组7例有腹部手术史者全部为粘连性梗阻,结合手术史,CT准确判断病因25例。腹部X线平片与CT假阴性诊断分别为4例和2例。结论 CT对发现肠绞窄和肠壁积气的敏感性较腹平片高。CT显示狭窄移行段的形态有助于判断病因,对梗阻病因的判断CT明显优于腹部X线平片。可为临床确定治疗方案提供比较可靠的依据。     

Small bowell volvulus - combined radiological findings]

PURPOSE: We retrospectively evaluated the radiological findings observed at plain abdominal film, abdominal sonography and abdominal CT performed in 66 patients with surgically proven small bowel volvulus. MATERIAL AND METHODS: Sixty-six patients (35 women and 31 men, ranging in age 38-77 years) with surgically proven small bowel volvulus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain film was performed in the upright position (postero-anterior view) in 46 cases, and in the supine position in 20 cases. On plain abdominal film we evaluated the following findings: bowel loops dilatation, air-fluid levels and site of obstruction. At abdominal US, performed with 3.5 e 7.5 MHz probes, we retrospectively searched for: bowel loop dilatation, bowel wall thickening, peristalsis alteration, extraluminal fluid. CT was performed with a helical unit (thickness 4 mm, reconstruction interval 4 mm, pitch 1.5), after intravenous contrast agent (120 ml) infusion (3 ml/s, 55 s acquisition delay from bolus starting) and using a power injector. The following CT findings were searched for: whirl sign, beak sign, extraluminal fluid, bowel loop dilatation, bowel wall thickening, bowel wall or mesenteric alterations. RESULTS: Plain abdominal film showed the following findings: air-fluid levels (92.4% of cases), bowel loops dilatation (71.2%), site of obstruction (42.4%). Abdominal sonography demonstrated bowel loop dilatation (48.5%), extraluminal fluid (48.5%), peristalsis alteration (27.3%), bowel wall thickening (27.3%). The most frequent CT findings were: bowel loop dilatation (95.5%), bowel wall thickening (78.8%), beak sign (69.7%), mesenteric alterations (66.7%), extraluminal fluid (54.5%), whirl sign (13.6%). CONCLUSIONS: Air-fluid levels and bowel loop dilatation were the most frequent radiological findings in our series. Plain abdominal film allowed us to identify signs of obstruction, whereas signs of bowel wall necrosis were accurately shown by abdominal CT.     

原发性肠道非霍奇金淋巴瘤的CT诊断

目的探讨原发性肠道非霍奇金淋巴瘤的CT表现特点。方法搜集经手术病理证实的原发性肠道非霍奇金淋巴瘤27例,对其CT表现作回顾性分析。结果小肠13例:浸润型11例,肿块型2例,病灶段肠腔呈"动脉瘤样扩张"6例,肠套叠1例,肠梗阻1例。回盲部3例:浸润型2例,肿块型1例,病灶段肠腔呈动脉瘤样扩张2例,肠套叠1例。结肠11例:浸润型5例,肿块型6例,病变段肠腔呈"动脉瘤样扩张"3例,肠套叠4例,继发肠梗阻1例。增强扫描25例,其中病灶全层轻度到中度均匀强化24例,仅粘膜下层强化1例。结论原发性肠道淋巴瘤CT表现具有一定特点,有助于诊断与鉴别诊断。     

儿童肠及肠系膜钝性创伤的CT诊断

目的：探讨CT检查对儿童急性肠及肠系膜钝性创伤的诊断价值。方法：分析11例经临床诊断或手术证实的儿童肠及肠系膜钝性创伤CT表现，全部病例均有明确的腹部外伤史，6例手术治疗，5例保守治疗。结果：11例患者中，胃损伤1例，十二指肠损伤3例，小肠及肠系膜损伤7例。CT表现有气腹、腹腔积液、肠壁肿胀、肠系膜模糊、肠管扩张等。在手术治疗的6例中，胃穿孔1例，小肠穿孔4例．肠壁血肿1例。结论：CT诊断肠及肠系膜急性钝性创伤明显优于X线平片和B超检查。不仅可清晰显示少量腹腔积气，估计腹腔积液、积血的量，显示实质脏器损伤，还可直接显示肠壁、肠系膜血肿，对外科医生确定治疗方案有重要意义。