改良鼻空肠导管在空气稀钡造影中的应用

目的:探索一种便捷、安全、方便的鼻空肠导管及插管方法,并应用于空气稀钡造影.方法:将改良后的鼻空肠导管先端塑成盘状侧翼,在临床上用于空肠空气稀钡造影检查,分析总结应用效果.结果:共用于59例,其中经盲插法在4～6 h内到空肠53例,成功率89.93%.失败6例,透视发现导管在胃内打圈.该6例经胃镜辅助置管十二指肠,置管时间4～6 h,在第6 h透视空肠管均达空肠.59例在完成置管后行空气稀钡造影检查,除开始时有恶心、呕吐、咽喉不适外,无一例出现并发症,亦无空肠管自行从空肠滑出现象.结论:改良鼻空肠导管价廉、简捷、安全、有效,有临床推广价值.     

X线引导下鼻空肠管置入及临床应用

目的 探讨X线透视下鼻空肠管的置人及其临床应用价值.方法 89例因疾病限制不能经口进食而生命体征相对平稳的危重病患者,鼻空肠管经一侧鼻孔插入,在X线引导下将鼻空肠管插至十二指肠曲氏韧带附近或更远处的小肠.结果 全部病例鼻空肠管均顺利通过幽门插入预定位置,平均置管时间为14.5 min(7～55 min).置管中及置管后未发生严重并发症.经鼻空肠管滴(注)入营养液,促进了患者消化道功能恢复,改善了机体的营养状况,效果满意.结论 X线引导下经鼻鼻空肠管置入是一种安全、经济、有效的肠内给养途径,因而具有广泛的临床应用价值.     

经鼻瘘腔内置引流管治疗食管癌术后吻合口-纵隔瘘6例

目的 回顾性分析X线监视下经鼻瘘腔内置入引流管的方法治疗食管癌术后吻合口-纵隔瘘的可行性.方法 2015年8月至2016年1月,6例经食管造影及胸部CT证实为食管癌术后吻合口-纵隔瘘的患者,在X线监视下,经鼻在导丝引导下于纵隔瘘腔内置入引流管并持续负压吸引,如患者未放置营养管,则经同一鼻孔置入空肠营养管.结果 6例患者全部成功置入瘘腔引流管及空肠营养管,1例患者在置管后5d因引流管堵塞,重新置入引流管.在X线监视下置管时间为23～48 min,平均33 min.6例患者均能够耐受,未出现经鼻置管并发症.经过持续负压吸引6～40 d(平均23 d),患者瘘口愈合.结论 X线监视下经鼻瘘腔内置入引流管治疗食管癌术后吻合口-纵隔瘘的方法简便、安全、有效.     

内镜经鼻安置小肠营养管术的护理配合

目的:探讨采用内镜经鼻安置小肠营养管术的护理效果.方法:将小儿内镜经鼻腔咽部送至十二指肠降段,于内镜活检孔道内插入导丝至十二指肠降段的远端,在逐步插入导丝的同时,等距离地退出内镜;沿导丝将营养管插入至十二指肠远端或空肠上段,固定营养管,将导丝拔出,即完成营养管安置过程.结果:278例安置小肠营养管术患者,经护理全部成功.结论:内镜经鼻安置小肠营养管术对脑出血、脑血栓形成、脑外伤、重症胰腺炎、上消化道出血患者治疗后需要肠内营养支持的患者,提供了一种安全、快捷、简单营养补给方法.适当的护理,能大大地减轻患者的痛苦,提高置管的成功率.     

两种胃镜辅助下放置空肠营养管临床对照研究

目的探讨一种改良法放置空肠营养管的临床有效性及可行性。方法选取2013年8月至2015年6月在解放军105医院内镜中心50例放置空肠营养管患者作为研究对象,随机分为传统方法组(A组,30例)和改良方法组(B组,20例)。A组先在鼻肠管头端系一长约1~2 cm的手术结线头,在胃镜直视下用异物钳钳夹结线头并推送胃镜,将其送至Treitz韧带以下;B组采用经鼻超细胃镜放置导丝至十二指肠远端,再循导丝放入空肠营养管。观察并比较两组置管成功率、并发症发生率及置管时间。结果两种方法空肠营养管置管成功率均为100%,其中,鼻胃管18例,鼻肠管26例,三腔鼻肠管6例。1例使用改良方法置管后鼻肠管在胃腔内盘曲,调整时鼻肠管脱入胃腔,重新置管后成功。两组患者均无严重并发症发生。在置管时间方面,A组置管时间平均为(15.0±1.1)min,B组平均为(10.2±0.9)min,两组间比较,差异有统计学意义(P<0.05)。结论两种空肠营养管放置的方法均能成功放置空肠营养管,但与传统方法相比,改良方法放置空肠营养管更简便、快速。     

MSCT小肠造影与双气囊小肠镜联合诊断小肠间质瘤的价值

目的:探讨多层螺旋CT(MSCT)小肠造影与双气囊小肠镜(DBE)联合检查在小肠间质瘤诊断中的临床应用价值。方法:回顾性分析经手术病理确诊的小肠间质瘤患者15例,所有病例术前均已行MSCT小肠造影和DBE检查,探讨两者对小肠间质瘤诊断的敏感性和正确性。结果:本组15例小肠间质瘤中,良性2例,交界性4例,恶性9例,15例病灶MSCT小肠造影均可清楚显示,3例腔外型小肠间质瘤DBE检查仅表现为局部肠壁压迫、隆起改变。结论:MSCT小肠造影操作简便、易行,患者耐受性良好,能显示肠镜不能通过的狭窄段;DBE检查图像清晰、直观,可以通过活检对病灶进行定性检查。两种方法联合检查在诊断小肠间质瘤时可以优势互补,对小肠间质瘤的术前定位、定性以及鉴别诊断均具有较高的临床应用价值。     

插管法小肠造影在诊断中的价值

一、一般资料我院近三年开展小肠插管造影共12例，其中7例在插管前施行过肠系造影检查，发现小肠肠管狭窄有4例，大多数因小肠肠管冗长，难以避开病变部位，图像显示不清，在消化科，放射科医师的共同探讨下，采用了上述检查方法。开展此方法，适用于消化道不明原因出血患者，上消化道及钡剂灌肠未发现病变者，肠系造影发现小肠     

经胃镜置鼻空肠管或支架在治疗食管吻合口瘘中的应用

目的：评价经胃镜置鼻空肠管或支架治疗食管癌术后吻合口瘘的疗效。方法：对15例食管癌术后吻合口瘘的患者，分别采取经胃镜安置鼻空肠管进行胃肠减压＋空肠营养法10例或安置可回收支架5例进行治疗。结果：胃肠减压＋空肠营养法，置管成功率100％，置管1～3个月，平均（38．5&#177;13．6）d，9例吻合口瘘愈合，1例死亡；安可回收支架5例，第30d瘘口均愈合，4例成功取出可回收支架，另1例取支架失败。结论：对适宜的食管癌术后吻合口瘘病例，可采用经胃镜置鼻空肠管或支架治疗，效果较好。     

数字化小肠气钡造影在小肠病变中的诊断价值

目的 评价数字化小肠气钡造影在诊断小肠病变中的用途。方法 22例经手术病理证实的小肠病变，其中，恶性病变10例，良性病变12例，均经数字化小肠气钡造影。结果 在22例患者中，数字化小肠气钡造影正确诊断19例，1例空肠腺癌被误诊为炎症，2例空肠增殖性结核被误诊为恶性占位性病变。诊断敏感性、特异性、准确率、阳性预测值以及阴性预测值分别为80%，92%，87%，89%以及92%。结论 数字化小肠气钡造影对小肠病变具有较高的诊断与鉴别诊断能力，对临床上疑有小肠病变的患者应作为首选方法。     

小肠不全性梗阻的钡剂造影(附23例分析)

目的　探讨钡剂造影对小肠病变所致梗阻的诊断价值。方法　对 2 3例经手术证实的因小肠病变所致不全性梗阻患者行钡餐及小肠插管注钡造影进行回顾性分析。结果　 2 3例小肠梗阻患者中 ,恶性病变 14例 ,良性病变 9例。结论　对小肠病变所致不全性梗阻 ,钡餐及小肠插管气钡双重造影检查均有重要的诊断价值。     

内镜导引下插管小肠双对比造影50例分析

目的:通过改进小肠插管技术,提高小肠检查率和小肠病变的发现率。方法:经胃内镜引导把B-D导管置入空肠上部。结果:50例病人插管成功率100%(50/50);满意率98%(49/50);病变阳性率86%(43/50)。结论:胃内镜导引下小肠插管双对比能明显提高小肠检查率和小肠病变发现率,可作为常规应用。     

胃镜引导插管小肠双对比造影方法研究

目的：探讨小肠双对比造影检查的有效方法。方法：72例受检者被随机分成2组；试验组(36例)应用研制的小肠造影导管，在胃镜直视下钳夹导管头端并送达十二指肠水平部，头端气囊充气固定导管，退出胃镜后，经导管灌注适量稀钡胶浆及空气行小肠双对比造影。对照组(36例)采用改进的F9心导管在透视下插管。结果：实验组插管成功35例(成功率97．1％)，对照组插管成功27例(成功率75％)。结论：研制专用的小肠造影导管并经胃镜引导插管行小肠双对比造影检查，其成功率明显高于普通插管方法。     

Rotational three-dimensional cholangiography--initial clinical experience

PURPOSE: The purpose of this study was to evaluate the feasibility and image quality of a novel biliary imaging technique that obtains 3D cholangiography image sets by infusing contrast material through a PTC-drainage tube, using 3D-digital subtraction angiography (DSA). METHODS: We applied this technique to seven patients suspected of having biliary disease. All patients underwent PTCD because of obstructive jaundice. Contrast material was introduced through the drainage tube, and the raw data were then transferred automatically to a workstation. Approximately 3 minutes of user time was required to generate the 3D images following image acquisition. RESULTS: Three-dimensional cholangiography was obtained in all patients who underwent 3D-DSA examination. Acceptable quality 3D-DSA cholangiograms were generated in six of the seven patients. CONCLUSION: We emphasize that our new technique may help during surgery as an aid to understanding anatomical structures in the biliary system.     

载体介导靶向小肠气钡双对比造影法的研究

目的 介绍一种简便易行的小肠双对比造影法－载体介导靶向小肠气钡双对比造影法并初步评价其效果。材料与方法 以小肠溶空胶囊为载体盛装产气剂，口服后载体胶囊至小肠溶解，产生CO2，配合口服钡剂形成小肠气钡双对比。选取80例拟行小肠造影检查者，随机分成2组，每组40例。试验组采用本方法，对照组采用普通单钡法。结果 试验组29例小肠双对比效果较满意，8例效果一般，有局部小肠双对比效果，3例无双对比效果，总有效率92．5％。对照组40例均为单钡造影效果。结论 载体介导靶向小肠气钡双对比造影法确能形成小肠气钡双对比，小肠观察效果较普通单钡法有明显提高，但有待于进一步完善。     

小肠原发性恶性肿瘤的临床X线诊断(附21例分析)

目的 :提高小肠恶性肿瘤的诊断水平。方法 :回顾分析 2 1例资料完整并经 X线检查和手术病理证实的小肠原发性恶性肿瘤的 X线征象。结果 :2 1例中平滑肌肉瘤 9例 ,腺癌 8例 ,恶性淋巴瘤 4例 ,各有其比较特征性 X线表现。结论 :小肠恶性肿瘤虽有各种不同的 X线表现 ,只要认真细致连续观察 ,仍可作出正确的诊断及鉴别诊断。小肠低张气钡双重造影是目前诊断小肠肿瘤比较可靠、首选的检查方法     

Value of small bowel double contrast enema in clinical interventions

The double contrast enema is the most effective morphological screening method for the evaluation of the whole small bowel. Its sensitivity is 85%, its specifity 96.7%. In specific clinical problems the number of pathological roentgen findings rises: from 34.4% when all indications are taken into consideration to 58% in indications specific to the small intestine such as Morbus Crohn or the malabsorption syndrome. Search for tumours and the double contrast of the small bowel in unclear gastro-intestinal bleeding are unproductive. The weak point of this screening method is the lower part of the small intestine. Therefore, the selective peroral or retrograde analysis of the terminal ileum supplement the contrast method. A precondition for good results is an adequate technical standard. Besides the clinical results some technical results are therefore discussed such as contrast medium quantities, examination and X-ray time, radiation exposure and influences on the image quality.     

80kV条件下碘克沙醇（270mgI/mL）在CTPA检查中的研究

目的：探讨80 kV 条件下碘克沙醇(270 mg I/mL)应用于 CT 肺动脉血管成像(CTPA)检查的可行性。方法将90例拟行 CTPA 检查的患者随机分为 A 组和 B 组。A 组45例：应用270 mg I/mL 碘对比剂同时使用自适应统计迭代重建(ASIR),管电压为80 kV,自动 mA;B 组45例：应用370 mg I/mL 碘对比剂同时使用滤波反投影(FBP)重建,管电压为120 kV,自动 mA。2组使用对比剂的总量均为40 mL。记录2组的容积 CT 剂量指数(CTDI)、剂量长度乘积(DLP)。对2组图像质量进行双盲法评分;采用两独立样本 t 检验比较2组患者的有效辐射剂量、平均 CT 值、图像噪声、图像信噪比(SNR)、对比噪声比(CNR)、图像质量评分等,并对2组患者的阳性率以及碘摄入量进行比较。结果CTPA 共检查出肺动脉栓塞(PE)53例(A 组24例,B 组29例),A组显示 PE 的阳性率(53.33%)与 B 组(64.44%)差异均无统计学意义。2组均可以显示4~6级肺动脉分支,图像质量均符合诊断要求,主观评分的差异无统计学意义(P >0.05)。2组患者的性别、年龄和体质量指数(BMI)的差异均无统计学意义。A 组的肺动脉平均 CT 值和噪声分别高于 B 组,差异有统计学意义(P <0.01)。A 组的 SNR 和 CNR 低于 B 组,差异有统计学意义(P <0.01)。结论在80 kV 条件下应用碘克沙醇(270 mg I/mL)行 CTPA 检查,获得的图像可满足临床需求,降低了辐射剂量并减少了对比剂的摄入量。     

Arterial angiography in high-kilovoltage technique with gadolinium as the contrast agent: first clinical experience

Iodine-containing contrast agents are currently used for angiography. However, due to the relatively low atomic number of iodine, imaging must be performed with a relatively low tube voltage. Gadolinium has been used for several years as a contrast agent in MRI with low adverse side effects. This substance has a higher atomic number as compared with iodine. We investigated whether the use of a gadolinium-containing contrast agent with a higher tube voltage reduces the radiation exposure in angiography, and how the image quality compares with the previous technique. A total of 15 patients were examined with either a survey angiography or a selective angiography. In all patients angiography was performed with an iodine-containing contrast agent with a tube voltage of 75 kV. Then gadolinium-containing contrast agent was administered immediately with a tube voltage of 110 kV. Radiation exposure and image quality were compared. On average, a dose reduction factor of 3.57 times was achieved by using 110 instead of 75 kV. However, the image quality was poorer in the majority of cases as compared with the images taken with iodine as a contrast agent and a tube voltage of 75 kV. The poorer image quality is caused by the relative low concentration (0.5) m of the used gadolinium solution. A 1 m solution is currently tested for market approval and would probably solve this problem. Correspondence to: F. Fobbe     

64排螺旋CT冠脉成像中双筒注射技术探讨

目的:探讨64排螺旋CT冠状动脉成像中,应用双筒注射技术消除上腔静脉伪影的作用。方法:182例疑冠心病的患者行64排螺旋CT冠状动脉成像,采用双筒高压注射器,高速注射对比剂后立刻以相同流率注射30~50ml生理盐水。评价上腔静脉伪影对图像质量的影响,图像质量分优、良和差3个等级。结果:本组中CT冠脉成像质量优者占85%,良占14%,差占1%。结论:通过采用双筒高压注射器,可消除上腔静脉和右心房内潴留对比剂而产生的伪影,提高64排螺旋CT冠状动脉成像质量。     

Reduction of absorbed dose in storage phosphor urography by significant lowering of tube voltage and adjustment of image display parameters

Purpose: To investigate whether image quality in storage phosphor urography can be maintained when the X-ray tube voltage is significantly lowered to give a lower patient dose.

Material and Methods: Initial phantom studies were used to establish exposure settings at 53 kV that gave signal-to-noise ratios for contrast media structures equivalent to those obtained at the reference kilovoltage of 69 kV. Dose area product and image quality, assessed by image quality criteria and visual grading, were then recorded for 44 patients drawn at random to be examined by either the standard or modified technique.

Results: Absorbed dose could be reduced by more than 30% without any significant change in image quality in manually controlled exposures and by 13% in exposures controlled by AEC.

Conclusion: It might be possible to lower the tube voltage in digital examinations involving contrast media as a means of lowering patient dose. The image display parameters need to be adjusted to maintain image quality.