剖宫产术后急性结肠假性梗阻诊治分析

目的分析剖宫产术后并发急性结肠假性梗阻临床特点,为临床进一步诊断治疗提供帮助。方法回顾性分析14例剖宫产术后并发急性结肠假性梗阻患者的临床表现、治疗方式和治疗结果等临床资料。结果 14例患者肠梗阻发作时间为剖宫产术后2～5 d,均有机械性肠梗阻的临床表现,主要以进行性腹胀为主要特点,较少剧烈腹痛,极少有肠坏死和穿孔并发症。11例患者经胃肠减压、禁食水、生长抑素静注和灌肠等保守治疗治愈,3例保守治疗效果欠佳,经结肠镜减压后痊愈,无死亡病例。结论剖宫产术后急性结肠假性梗阻绝大多数为功能性梗阻,可通过保守治疗和结肠镜减压等非手术方法治愈,预后良好,应与器质性结肠梗阻相鉴别,避免不必要的剖腹探查。     

钡剂灌肠在诊断婴幼儿先天性巨结肠中的价值

目的探讨钡剂灌肠在婴幼儿先天性巨结肠中的应用价值。方法收集经手术或病理证实、并于术前行钡剂灌肠检查的先天性巨结肠患儿23例,对其钡剂灌肠影资料进行回顾性分析。结果钡剂灌肠见典型病例17例,痉挛段(16例)、移行段(14例)、扩张段(16例),不典型病例6例,直肠下端局限性切迹(4例)、直肠或乙状结肠下段螺旋征(2例),不典型病例经24h随访摄片均见钡剂残留。结论钡剂灌肠对诊断婴幼儿先天性巨结肠有重要价值。     

结肠癌伴发急性梗阻的外科治疗

目的：探讨结肠癌伴发梗阻的术前诊断和外科治疗问题。方法：复习文献，结合9年中治疗的结肠癌伴发梗阻病例的临床资料进行回顾性分析和总结。结果：67例中60岁以上41例，左半结肠癌伴梗阻42例，右半结肠癌伴梗阻16例，直肠9例；本组绝大多数术前诊断依靠腹部X平片和钡剂灌肠。51例行I期肠切除吻合术，发生吻合口漏2例。结论：对疑为结肠癌引起梗阻的病人，在术前诊断上应首选X线腹部平片和钡剂灌肠。尽管在急性梗阻时行1期结肠切除吻合有发生吻合口漏的危险，但只要掌握好手术适应症，处理好手术的各个环节，1期结肠切除吻合术是安全可行的。     

结肠慢传输型合并出口梗阻型便秘的诊断及手术治疗

目的探讨结肠慢传输型合并出口梗阻型便秘的诊断及手术治疗方法。方法回顾性分析2003～2006年治疗的结肠慢传输型合并出口梗阻型便秘12例患者的临床资料。结果12例患者经排便造影、结肠传输试验及钡剂灌肠检查确诊,均接受直肠通道矫正手术及部分结肠切除手术,效果良好,症状明显改善。结论对结肠慢传输型合并出口梗阻型便秘的患者,排便造影、结肠传输试验及钡剂灌肠检查是确诊的方法,直肠通道矫正手术及部分结肠切除术是一种理想的手术方式。     

21例小儿先天性巨结肠症的钡灌肠X线影像学表现

目的:评价钡剂灌肠X线检查对小儿先天性巨结肠的诊断价值。方法:回顾性分析21例经手术、病理证实的小儿先天性巨结肠的钡灌肠方法和X线影像学表现。结果:21例先天性巨结肠患儿经钡灌肠检查确诊20例,误诊1例,诊断准确率高达95.2%。结论:钡剂灌肠检查为诊断本病首选、有效、简单的方法,且诊断准确率高。     

以急性肠梗阻为表现的结肠癌患者诊治体会

目的总结31例结肠癌并急性肠梗阻的诊断、治疗经验。方法对结肠癌并急性肠梗阻的诊断、手术治疗的术前准备、手术时机、手术方式选择进行分析。结果本组术前能确诊为结肠癌的15例全部依靠钡剂灌肠。右半结肠癌7例,左半结肠癌15例行Ⅰ期切除吻合,术后均无吻合口瘘;右半结肠癌2例,左半结肠癌5例行Ⅰ期切除近侧结肠造瘘。本组死亡3例。结论钡剂灌肠检查是结肠癌急性梗阻病因诊断惟一有效的辅助检查方法。只要患者一般情况好,中毒症状轻,均应争取Ⅰ期切除吻合。术中结肠减压及灌洗是左半结肠癌安全进行结肠Ⅰ期切除吻合的重要措施。     

结肠癌合并肠梗阻31例诊治体会

目的总结31例结肠癌并急性肠梗阻的诊断、治疗经验。方法对结肠癌并急性肠梗阻的诊断、手术治疗的术前准备、手术时机、手术方式选择进行分析。结果本组术前能确诊为结肠癌的15例全部依靠钡剂灌肠。右半结肠癌7例,左半结肠癌15例行Ⅰ期切除吻合,术后均无吻合口瘘;右半结肠癌2例,左半结肠癌5例行Ⅰ期切除近侧结肠造瘘。本组死亡3例。结论钡剂灌肠检查是结肠癌急性梗阻病因诊断惟一有效的辅助检查方法。只要患者一般情况好,中毒症状轻,均应争取Ⅰ期切除吻合。术中结肠减压及灌洗是左半结肠癌安全进行结肠Ⅰ期切除吻合的重要措施。     

结肠运输试验及排粪造影诊断便秘的临床应用

目的:探讨便秘的病因,通过结肠运输试验及排粪造影检查,评价影像学对便秘诊断的准确性及临床应用价值.方法:对183例临床诊断便秘的患者先作结肠运输试验,考虑出口梗阻的患者冉作排粪造影检奁,根据龚水根教授的测量指标及诊断标准作出诊断,进行回顾性分析.结果:结肠运输试验异常共169例,真性慢传输36例,假性慢传输49例,出口梗阻127例,其中合并结肠慢传输43例.结论:结肠运输试验及排粪造影检查是一种简单无创的、最佳的诊断便秘病因的检查方法,通过动态、静态结合观察结肠的运输动力及排便的生理过程的影像学表现,特别是二者的结合应用,能够更加明确结肠慢传输与功能性出口梗阻所致便秘的病因,帮助临床医生制定行之有效的治疗方案,是明显优于传统钡剂灌肠和纤维结肠镜不可替代的检查方法.     

结肠癌合并肠梗阻31例诊治体会

目的 总结31例结肠癌并急性肠梗阻的诊断、治疗经验。方法 对结肠癌并急性肠梗阻的诊断、手术治疗的术前准备、手术时机、手术方式选择进行分析。结果 本组术前能确诊为结肠癌的15例全部依靠钡剂灌肠。右半结肠癌7例，左半结肠癌15例行Ⅰ期切除吻合，术后均无吻合口瘘；右半结肠癌2例，左半结肠癌5例行Ⅰ期切除近侧结肠造瘘。本组死亡3例。结论 钡剂灌肠检查是结肠癌急性梗阻病因诊断惟一有效的辅助检查方法。只要患者一般情况好，中毒症状轻，均应争取Ⅰ期切除吻合。术中结肠减压及灌洗是左半结肠癌安全进行结肠Ⅰ期切除吻合的重要措施。     

小肠灌肠双重对比造影对小肠疾病的影像诊断

到目前为止 ,小肠病变最常用的检查方法还只能依靠钡剂造影检查 ,内窥镜、B超检查对小肠疾病的影像诊断帮助不大。常规口服钡剂检查不能快速、同时、短时间显现整个小肠形态。我院自 2 0 0 0年采取小肠灌肠双重对比造影 (smallbowelenema ,SBE)检查 ,取得了较满意的影像检查诊断。1　资料与方法1 .1　病例选择 :为经胃镜或胃、十二指肠钡餐检查和结肠镜或钡灌肠检查阴性 ,临床上却有消化道症状而怀疑小肠疾病病例。检查范围自十二指肠至回盲瓣。但十二指肠及盲结肠病例不在本文中讨论。1 .2　肠道准备 :检查前一天下午大量饮水 ,晚 9:0 0…     

不用清洁灌肠的结肠清洁法在结肠双对比X线检查中的效果观察

本文对不用清洁灌肠的结肠清洁方法连续运用５１９例，并对其效果进行评价。本清洁法程序包括限制饮食、大量饮水及泻剂的运用。本文分析了５１９例结肠的清洁效果，井与其他方法进行比较。分析结果显示采用本清洁法的５１９例中，结肠清洁度达良好者４８６例（占９３．６％），与其他方法效果相仿，但本方法更简便、有效。因而，结肠双对比检查病人的结肠清洁可不用清洁灌肠了。     

新生儿肠旋转不良的诊疗分析

目的分析新生儿肠旋转不良的临床特点及诊治方法。方法35例行Ladd术的新生儿肠旋转不良的患儿,所有病例术前均行腹部平片检查,16例行钡剂灌肠造影检查,12例行上消化道造影,7例接受彩色多普勒超声检查。结果33例患儿合并中肠扭转,33例患儿存活,无严重术后并发症,2例放弃治疗。结论肠旋转不良易并发急性肠扭转,肠梗阻,口服和灌肠的消化道造影是诊断本病的最可靠依据。Ladd式手术是本病手术治疗的最佳选择。     

Adequacy of preparation for barium enema among elderly outpatients.

OBJECTIVE: To determine whether outpatients 75 years of age or older have a higher rate of inadequate bowel preparation for barium enema and of complications associated with the preparation and the test than patients aged 55 to 74 years. DESIGN: Cross-sectional survey. SETTING: Radiology department in a teaching hospital. PATIENTS: Patients 55 years or older referred for a barium enema from March to August 1988. OUTCOME MEASURES: All films were reviewed independently by a study radiologist blind to the staff radiologist's report. Patients were interviewed by telephone within several days after the test to assess the occurrence of problems during the preparation or the test. MAIN RESULTS: Of the 213 patients assessed 72 were excluded: 43 refused to participate or could not be contacted, 16 had previously undergone colonic surgery, and 13 were excluded for other reasons. The remaining 141 patients were separated into three age groups: those 55 to 64 years (46 patients), those 65 to 74 (47) and those 75 or older (48). In 104 cases (74%) the bowel had been prepared adequately; there was no significant difference between the three groups with regard to the adequacy of preparation. The incidence of problems reported by the patients did not differ significantly between the groups. CONCLUSIONS: Outpatients aged 75 years or more are no more likely than those aged 55 to 74 to have problems with bowel preparation or the barium enema itself. Age should not be a criterion for exclusion from barium enema. To try to lower the rate of poor bowel preparation clinicians and radiologists should consider counselling patients more carefully about the importance of proper preparation. Also, the current method of preparation could be examined to determine whether simple changes would significantly improve colon cleanliness.     

Importance of total colonoscopy in the diagnosis of colonic disorders

The need for colonoscopic examination of the whole colon was determined by evaluating the accuracy of a barium enema X-ray report with particular reference to the right colon. Long colonoscopies were performed on 108 patients. The reports of the barium enema X-ray examination in these patients were compared with the colonoscopy reports. Over all, the barium enema X-ray report was accurate in 47% of cases. The rate of false negative reports was 10% and that of false positive reports 43%. For lesions of the right colon, the barium enema X-ray report was accurate in only 32% of cases, with 68% false positive and 15% false negative reports. False positive reports of carcinoma or polyps result mainly from imperfect preparation. Of the eight right colonic lesions missed in the barium enema X-ray examination, five were polyps and one was carcinoma. Long colonoscopy, rather than short colonoscopy, or flexible sigmoidoscopy and barium enema X-ray examination, would be accompanied by the greatest diagnostic accuracy. Air-contrast barium enema X-ray examination and long colonoscopy together offer the best methods of diagnosis of occult lesions in the right colon.     

小儿肠套叠应用空气或钡灌肠加压整复对比分析

目的评价小儿肠套叠在X线电视监视下进行空气灌肠加压整复方法与钡剂灌肠加压整复方法的临床应用价值。方法对86例经临床、X线检查确诊的小儿肠套叠分别进行空气灌肠加压整复38例,钡剂灌肠加压整复48例。结果空气灌肠加压整复方法达到完全整复35例,不能整复3例,整复成功率为92.11%;钡剂灌肠加压整复达到完全整复48例,整复成功率为100%。两组比较,差异有统计学意义（χ2=3.93,P〈0.05）。结论小儿肠套叠采用钡剂灌肠加压整复方法具有较高临床应用价值。     

X线诊断不典型先天性巨结肠

目的:提高对新生儿先天性巨结肠的各种X线征象的认识,以求早期诊断.方法:对60例不典型新生儿先天性巨结肠的腹平片、钡灌肠结肠造影、临床资料、手术及病理资料进行了回顾性分析,并与60例典型新生儿先天性巨结肠资料做了对比分析.结果:患儿日龄越小,其钡灌肠结肠造影的X线征象越不典型,但在对比分析中找出几种有诊断意义的X线征象.结论:可将几种有诊断标准意义的X线征象进行综合,提出诊断标准供参考,并提出几点钡灌肠结肠造影的注意事项.     

小儿先天性巨结肠的X线检查

目的：对小儿先天性巨结肠患者采用X线进行检查,观察该病X线检查的表现。方法对74例小儿先天性巨结肠患者分别采用X线平片和钡剂灌肠造影进行检查,分析检查结果。结果3例患者通过平片确诊;71例患者通过造影确诊,其中69例稀钡灌肠确诊,2例全消化道造影确诊。结论对患者通过钡剂灌肠检查,能够将小儿先天性巨结肠比较典型的X线表现清晰地显示出来,诊断结果可靠,是临床影像学检查中首选的方法。     

小儿全结肠型巨结肠的X线诊断

目的分析评价X线在TCA的影像特点及诊断价值。方法对经手术病理证实的13例小儿TCA的腹部平片及钡灌肠征象进行回顾性分析。结果13例腹部平片均显示异常，表现为不同程度小肠淤张、结肠少气或无气，结合临床可提示巨结肠可能；钡灌肠显示：结肠框变小10例，整个结肠壁较平坦、僵直、缺乏正常的柔韧度与活动度9例，部分结肠壁不光整、呈现齿状突起5例、钡剂逆流、末端回肠扩大9例，24h钡剂潴留8例。钡灌肠正确诊断TCA10例，诊断准确率达76．9％。结论腹部平片异常可提示巨结肠，是诊断TCA的首选方法；钡灌肠可以正确诊断TCA，是目前诊断TCA主要的影像检查方法．正确合理使用检查方法、掌握TCA影像特征表现．对早期诊断TCA具有萤大的意义．     

Detection of intracolonic lesion by barium contrast enema. The importance of adequate colon preparation to diagnostic accuracy.

Frequently, the clinical significance of the barium contrast enema is minimal because of inadequate colon preparation prior to examination. The frequency of false-positive routine barium enemas was 17% in 230 consecutive patients who underwent colonoscopy for removal of specific radiographically identified polypoid colon lesions. Initial barium enema inaccuracies were documented with postendoscopic air-contrast radiography in colons that were endoscopically proved to be mechanically clean following a two-day colon preparation. These results suggest that more emphasis on a two-day colon preparation, before the initial barium contrast enema, would substantially reduce the frequency of false-positive interpretations.     

电脑灌肠整复仪在小儿肠套叠诊治中的临床应用

目的探讨新型电脑整复灌肠仪对小儿肠套叠诊治的临床应用价值和灌肠整复的技术要点。方法对54例急性肠套叠患儿,按照规范的操作流程,使用电脑遥控灌肠整复仪行空气或气钡双重灌肠。结果本组54例小儿肠套叠中,一次复位成功30例,二次复位成功15例,总体灌肠复位成功率83%。结论应用电脑遥控灌肠整复仪,按照规范的操作流程,能提高整复成功率,是目前小儿肠套叠首选诊治技术。