消化道血管二维彩超的探寻与临床意义之二--病变肠道与血管的二维彩色血流图

目的 探寻肠道病变肠壁、血管二维彩色血流表现及其价值。方法 高性能彩超经腹部与腔内检查45例，包括：肠癌、腹股沟疝、腹腔炎症、肠粘连、肠梗阻、内外痔等。结果 各病变肠壁、肠管间及血流声像图不同：肠癌血管增多血流丰富；炎症、粘连，充血水肿动静脉血流网状交叉；肠管动力异常致血流改变等。对临床诊断、鉴别有一定意义。结论 高性能彩超检查能显示以往不易看到的肠管病变的血流状态，各病不同有助临床诊断。     

二维及彩超在乳腺良恶性肿块鉴别诊断中的价值

目的 探讨二维及彩超在乳腺良恶性肿块鉴别诊断中的价值。方法 45例肿块经二维超声了解其形态、边界、边缘、内部回声、有无后方衰减及侧方声影；然后用彩色多普勒检查，观察肿块内部血流丰富程度，并根据其丰富程度分成4个等级，并测量阻力指数。结果 良恶性乳腺肿块二维声像特征存在一定重叠；二者血流丰富程度及阻力指数有助于鉴别诊断。结论 二维声像图与彩色多普勒相结合，在乳腺良恶性肿块的鉴别诊断中，有着重要的诊断价值。     

彩超对椎动脉起始部血管狭窄的观察

目的：探讨椎动脉起始部狭窄所导致的相应血管内径、血流状态、血流参数的变化。方法：测量椎动脉颈段内径；观察椎动脉起始部管腔内膜情况及血流颜色；频谱多普勒用于测量椎动脉起始部和颈段血流的收缩期峰值流速(PSV)，搏动指数(PI)，阻力指数(RI)，并将椎动脉起始部各血流参数(PSV、PI、RI)与相应的颈段血流参数进行相比。所得参数分别为RV、RPI、RRI。结果：44例患中，共检出狭窄血管84支，椎动脉起始部狭窄52支，正常为32支，起始部狭窄血管中，二维超声显示粥样斑块8支，彩色血流均呈杂色血流；起始段PSV、PI、RI、RV，狭窄组明显高于正常组；椎动脉正常组与狭窄组的颈段内径、PSV及RPI无显性差异；椎动脉颈段的PI、RI及RRI，狭窄组高于正常组。结论：椎动脉起始部血流呈杂色血流，频谱多普勒测得的PSV、PI、RI和RV明显升高，是椎动脉起始部血管狭窄的重要征象。     

彩超诊断下肢静脉血栓

目的探讨二维及彩色多普勒超声检查在下肢静脉血栓中的价值。方法应用二维及彩色多普勒超声对36例下肢深静脉血栓的患者进行检查，观察血管内径、血管内膜、血管腔内透声及血管腔内血流情况。结果急性下肢静脉血栓形成后血管内径明显增宽，血栓表现为均质低回声，慢性血栓凹声较高，血栓部位管腔无血流显示或血流充盈缺损。结论彩色多普勒超声检查不仪可诊断下肢静脉血栓，同时根据血栓形态、血栓回声、血管腔情况并结合临床予以分期，为临床选择治疗方法提供依据，是诊断下肢静脉血栓的首选方法。     

甲床根部血管球瘤的高频彩超诊断

目的 探讨甲床根部血管球瘤的临床表现及彩超特点，寻找有效的早期诊断方法。方法通过对手术切除并经病理证实的8例甲床根部血管球瘤的回顾性研究，分析其临床表现和超声特点。结果8例患者均经手术切除而确诊，高频彩超检查表现为瘤体较小，轮廓清晰，内部呈低回声，可见丰富的血流信号，呈彩球样，并可见动静脉瘘血流频谱。结论高频彩超是甲床根部血管球瘤简便、有效的早期诊断方法。     

外周血管疾病的彩色多普勒超声诊断

目的：探讨二维彩色多普勒超声（CDFI）对外周血管疾病检测的有效性。方法：对33例因多种原因所致外周血管疾病患者进行研究，采用CDFI对病变血管内径、内膜厚度、管腔变异、腔内斑块、血流速度、血流方向、与周边结构关系等进行详尽的检查探索，并与病史、临床、手术、病理结果及血管造影等其他检查方法相结合，以达到确切诊断的目的。结果：准确测出动脉狭窄8例、假性动脉瘤5例，动静脉瘘3例，动脉血栓4例，静脉血栓10例。结论：二维彩色多普动超声对外周血管疾病的检测具有无创、精确、方便、快捷等诊断价值。     

二维血流显像技术在颈动脉粥样硬化中的应用研究

目的：评价二维血流显像（B－Flow)在颈动脉粥样硬化中的应用价值。方法：对96例颈动脉粥样硬化患者进行B－Flow常规颈动脉检查,分别记录二维超声、彩色多普勒血流显像（CDFI）、功率图显像（PDI）和B－Flow声像图,光盘存储,以供分析。结果：正常颈动脉的B－Flow声像图显示动脉壁结构层次分明,内膜纤细光滑,血管内血流回声均匀一致,异常颈动脉的B－Flow则表现动脉壁不光滑,内膜业糙不平或有斑块突入管腔,B－Flow在斑块处呈“蚕蚀”现象,颈动脉分叉处血流呈旋涡状,回声强弱不均。用B－Flow测得的血管内径更接近于二维超声,从而解决了CDFI、PDI对狭窄血管内径的高估。结论：B－Flow以高帧频和高空间分辨力在显示血管解剖结构的同时,并实时显示动脉分叉和狭窄的病损血流动力学改变,从而为研究动脉粥样硬化的发生与发展以及采取相应的预防与治疗措施提供了直观的影像学资料。     

经直肠高频彩超对肛周脓肿的诊断价值

目的探讨经直肠高频彩超对肛周脓肿的诊断价值。方法应用高频双平面探头,对57例肛周脓肿患者进行经直肠彩色多普勒超声检查,分析肛周脓肿的声像特征。结果肛周脓肿的声像图与周围正常组织存在明显差异,脓肿表现为无回声区或低回声与混合回声区;脓腔内无血流信号,周边可见彩色血流信号,合并瘘管则表现为条索状无回声或低回声区。57例患者均经手术及病理证实为肛周脓肿。结论经直肠高频彩超对肛周脓肿进行诊断可作为首选方法。     

二维超声及彩超诊断未破型宫外孕

目的　探讨未破型宫外孕的超声诊断方法。方法　选择１６ 例经二维超声与彩色多普勒血流显像首诊,临床确诊的未破型宫外孕病例,对其超声检查资料进行分析。结果　全部病例均显示附件包块。１２ 例（７５ ％ ） 显示肿块内相对周围组织增多的彩色血流信号。频谱多普勒表现附件肿块内低阻血流频谱。ＲＩ值０４２ ±０．０８,子宫动脉及卵巢血流无特征性变化。结论　附件区肿块,肿块内相对周围组织增多的彩色血流信号是超声诊断未破型宫外孕的关键。输卵管妊娠的病理生理改变与超声图像表现相关。疑为宫外孕时,耐心细致地寻找附件包块至关重要。     

乳腺疾病的二维及彩色多普勒超声诊断分析

目的：对156例乳腺疾病患者进行了二维及彩色多普勒检查，总结各自的二维声像图特征和彩色多普勒血流状况，分析了二维超声和彩色多普勒在乳腺疾病中的诊断价值。结果显示，超声检查是诊断乳腺疾病的首选方法。     

罕见直肠肛管恶性肿瘤的临床与影像学诊断

【目的】探讨罕见直肠肛管恶性肿瘤的临床影像学表现。【方法】报道罕见直肠肛管恶性肿瘤15例．包括非何杰金氏淋巴瘤3例．平滑肌肉瘤9例，脂肪肉瘤2例，恶性黑色素瘤1例．15例中12例做了CT检查，9例进行了气钡灌肠检查。【结果】气钡灌肠示该类肿瘤主要表现为直肠下端或肛管隆起性病变．肠腔明显狭窄．可伴不规则龛影．肉瘤常较大．而恶性淋巴瘤常表现多发。CT表现为直肠或肛管肠壁增厚或局部肿块，肉瘤肿块常较大，多伴更低密度坏死区。邻近组织或器官可受累及。【结论】罕见直肠与肛管恶性肿瘤常用影像学检查方法为气钡灌肠与CT．其表现仅具有相对性特征。     

Endorectal color and duplex imaging of the normal rectal wall and rectal masses.

This study investigates the ability of endorectal ultrasonography aided by color flow and pulse wave Doppler techniques to identify submucosal arterial plexuses of the normal rectal wall and to detect vessels supplying rectal wall masses. Color flow and pulsed wave Doppler analysis of 62 normal submucosal arterial plexuses and vessels feeding rectal wall masses (one rectal endometriosis and seven rectal cancers) was performed. The color signals from normal submucosal arterial plexuses and the one case of rectal endometriosis were judged to be sparse or decreased in comparison to color signals from rectal cancers. The median and mean P1 values for normal submucosal arterial plexuses were significantly greater than those for the central feeding vessels or small peripheral vessels within rectal masses. Our experience with color and duplex endorectal ultrasonography suggests that different vascular structures exist in normal persons compared to those in rectal wall masses. Pathologically, rectal cancers possess vessels with and without a smooth muscle layer, which may produce the high and low resistance signals identified by pulse Doppler.     

Rectal duplication cyst successfully treated by laparoscopic total mesorectal excision using the prolapsing technique

Congenital alimentary tract duplication is a rare disease. It most frequently occurs in the ileum, with the rectum being the rarest site. Herein, we report a 38-year-old woman who was referred to our hospital because of severe anal pain. On digital examination, a smooth, round, rubbery mass was palpable; it was located 5 cm from the anal verge in the posterior rectal wall. A CT scan demonstrated a 5-cm cystic lesion located anterior to the sacrum that was displacing the rectum anteriorly. Spontaneous remission of the tumor was evident; however, after 5 months of follow-up, the patient experienced the same severe anal pain. MRI demonstrated a recurrent cystic lesion. To prevent further complications and to confirm or deny malignancy, laparoscopic total mesorectal excision using the prolapsing technique was performed. Pathologically, the cystic lesion was diagnosed as a rectal duplication cyst. This is the first report of a rectal duplication cyst successfully treated by laparoscopic total mesorectal excision.     

下段直肠及肛管CT轴位图像测量方法的研究

目的:研究直肠肛管的轴位CT测量方法。材料与方法:84例标记肛门的盆腔增强CT检查,其中15例同时行结肠气钡双对比检查。测量并计算直肠壶腹距肛门的实际长度与其层面距离的比值,同时在CT及气钡双对比造影图像上测量肛门距坐骨结节下缘平面的垂直距离、肛管长度及肛直角。用SPSS 11.5软件对数据进行统计分析。结果:在横轴位CT图像上,肛管由环行变为开口向后的U形时,即为肛门所在位置。CT与钡灌肠两种方法测量肛门距坐骨结节下缘平面距离、肛管长度及肛直角,差异无统计学意义。通过CT测量的直肠壶腹距肛门的实际长度与相应层面距离的比值均值为1.3。结论:CT图像可以清楚显示肛门及肛管,下段直肠距肛门的CT层面距离与实际长度间存在差异,通过本研究提出的比值法可以较准确的在轴位CT上测量下段直肠距肛门长度。     

Color Duplex evaluation of the mesenteric artery

Ischemic colitis is the most common form of intestinal ischemia. Diagnosis is made at clinical examination and endoscopy and completed by vascular imaging, but color Doppler US may become a first-line imaging technique for the evaluation of the mesenteric circulation.We present the case of an 80-year-old woman hospitalized for recurrent ischemic colitis of the sigmoid. At a previous hospitalization, color Doppler US examination showed medium to severe stenosis at the origin of the inferior mesenteric artery. However, CT angiography was negative and the condition was therefore misdiagnosed. Eight months later the patient was admitted again with abdominal pain and rectal hemorrhage. Rectosigmoidoscopy documented the presence of ischemia of the sigmoid mucosa. Angiography showed the presence of severe stenosis at the origin of the inferior mesenteric artery so revascularization was carried out by percutaneous transluminal angioplasty (PTA) during the same session. Follow-up showed normal patency of the inferior mesenteric artery after revascularization, and subsequent endoscopic evaluation documented gradual colonic mucosal ischemia resolution. Blood flow at the level of the inferior mesenteric artery was assessed using color Doppler US. The presented case confirms that color Doppler US is a valid first-line imaging technique in the assessment of ischemic intestinal lesions. It is reliable in the evaluation of the mesenteric arterial circulation, and it also allows assessment of blood flow alterations caused by stenosis and identification of localized hemodynamic stenosis which may be missed at CT-angiography or MR-angiography. Arteriography remains the examination of choice in case of discrepancy between first-and second-line imaging techniques and in all cases which offer the possibility of endovascular revascularization.     

Delayed presentation of congenital rectal stenosis associated with Down's syndrome and hypothyroidism: Case report

Rectal stenosis is a rare variety of rectal atresia. A membrane separates the rectum from the anal canal in the presence of a normal anus. We report a case of rectal stenosis associated with Down''s syndrome and hypothyroidism in whom rectal stenosis was diagnosed at the age of 17 years.     

Safe anastomosis in laparoscopic low anterior resection for rectal cancer

Introduction: In laparoscopic rectal surgery, there are some limitations on a surgeon's ability to maneuver, especially in transection of the lower rectum. To achieve minimally invasive surgery, safe anastomosis, including proper rectal transaction, is necessary. Methods: To overcome the difficulty in lower rectal resection, we followed a series of steps. First, we completely mobilized the rectum to the pelvic bottom, just above the anal canal, making the lower rectum mobile and allowing for an easy rectal transection. To secure the transaction, the mesorectum around the transection must be properly divided. We recommend placing the lower right quadrant port as caudal as possible to properly staple the rectum. We found a 60 mm compression‐type stapler most suitable for rectal transection. To wash and flatten the rectum, a detachable intestinal clip is quite useful because of its flexibility. Finally, in addition to conventional abdominal drains around the anastomotic site, we employed transanal tube to actively decompress rectal pressure inside the anastomotic site. Results: Between August 2009 and July 2010, 101 patients underwent laparoscopic low anterior resection using this technique. Most patients, 98.0% (99/101), underwent lower rectum transection using a single‐fire cartridge. The anastomotic leakage rate was only 1.0% (1/101) in total and 1.3% (1/78), when not including patients with diverting stoma. Conclusion: We have to follow up with more patients to conclude whether our technique is effective in the long term. However, this step‐by‐step technique could lead to safe anastomosis in laparoscopic low anterior resection for rectal cancer.     

慢性特发性便秘患者肛门直肠的感知阈值和动力学的改变

目的 探讨慢性特发性便秘(CIC)患者肛门直肠动力学特征，便秘的病因和发病机理。方法 采用PC Polygraf高分辨多道胃肠功能测定仪检测24例CIC患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受闽值及排便功能等指标，并与12例健康人进行对照。结果 CIC组直肠静息压、肛管括约肌静息压、最大缩窄压及肛管长度与对照组无显著性差异，但CIC患者的初始感觉、疼痛、排便等阈值，引起肛门直肠抑制反射的最低支气量和肛管内括约肌松弛压均高于正常对照组。模拟排便时，CIC组33．33％(8／24)的患者在直肠收缩时伴有肛管括约肌矛盾收缩。结论 CIC忠者直肠粘膜对容量刺激的反应性降低和排便时肛管括约肌的反向矛盾收缩可能是形成便秘的原因之一。     

Evacuation proctography: An investigation of rectal expulsion in 20 subjects without defecatory disturbance

Evacuation proctography is a dynamic investigation of rectal expulsion that records the voluntary evacuation of thick barium paste on videotape. Evacuation is a passive phenomenon in a defined zone of the rectum, associated with pelvic floor descent of 3 cm from a resting position of the anorectal junction <2 cm above the plane of the ischial tuberosities. The anal canal does not open immediately; it takes about 4.5 sec to open to a maximum diameter of 1.5 cm, with rectal emptying in 11 sec. Anterior rectoceles commonly invert over the anal canal as the rectum collapses in at the end of evacuation.