胃异位胰腺典型X线表现(附三例报告)

胃异位胰腺少见,如果在胃肠钡餐造影检查中,不能显示其特征性Ｘ线表现,极易漏诊和误诊。现将我们遇到的３例具有典型Ｘ线表现并经病理证实的胃异位胰腺报告如下,旨在提高诊断水平。 病例报告 例１男,４２岁。反复上腹痛、返酸半年。行上消化道钡餐造影检查,Ｘ线表现：胃窦部大弯侧距幽门２厘米处见－ １． ８ｃｍ×１． ５ｃｍ大小类圆形充盈缺损,边界清楚,边缘光滑,其中央处见－０．３ｃｍ×０．３ｃｍ大小点状钡斑。胃粘膜粗乱,于充盈缺损处展平,胃壁软（图１）。Ｘ线诊断：胃内占位性病变,符合胃异位胰腺。电子内镜示胃窦部…     

多发异位胰腺合并皮革胃一例

多发异位胰腺合并皮革胃一例刘长柱患者女，３２岁。半年前无诱因出现进食后腹胀，体重减轻约１０ｋｇ。近２个月呕吐频繁。影像学检查：Ｘ线钡餐检查可见胃腔变小，胃粘膜紊乱、局部消失。胃壁中等度僵硬，蠕动减弱。胃窦部大弯侧可见直径约３．５ｃｍ的椭圆形充盈缺损，...     

异位胰腺合并胃体癌一例

异位胰腺合并胃体癌一例任为端姜立民吕祥龙男，２７岁。因消瘦，腹胀月余就诊。Ｘ线胃肠造影显示，胃体部大弯侧有一不规则腔内龛影，龛周示环堤，局部胃壁僵硬。另于胃窦部见１．０ｃｍ×１．０ｃｍ圆形充盈缺损，边界光滑锐利，病灶中心有一钡斑，且见细管状影由此伸入...     

胃壁内迷走胰腺4例

胃壁内迷走胰腺一般认为是一种罕见病,国内曾报道8例。我们自1975～1978年遇到4例,均经手术及病理证实。特报告如下: 例1 男,25岁。无规律性上腹部隐痛1年,近半年来隐痛为持续性,伴有腹胀、恶心。体格检查除剑突下有轻度压痛外,余无特殊。化验检查正常。 胃肠造影:于胃窦部大弯侧可见一边缘光滑的约1.5×2cm的圆形充盈缺损,基底宽,不移动,内无龛影,周围粘膜正常。诊断为胃良性肿瘤,腺性息肉可能性     

胃癌合并胃脂肪瘤一例报告

患者男性,57岁,病例号:48490,上腹不适有胀满感半年余,食后上腹胀痛明显,无反酸,嗳气。查体无特殊。钡餐检查:胃体下部轮廓不规则狭窄,大弯侧有一充盈缺损,小弯侧加压下可见一龛影,局部粘膜中断,胃壁僵硬,蠕动消失。又于胃窦部偏小弯侧有一椭圆形充盈缺损,直径为3×4cm,边缘光滑,局部     

药物性胃石症一例

病例资料　患者 ,女 ,62岁。上腹部不适 ,疼痛 1周。恶心、返酸、纳差 ,尤以进餐后为著 ,并有明显的饱胀感 ,既住有十二指肠球部溃疡病史 ,并于就诊前 2周内服用肠溶乙酰螺旋酶素片。查体 :腹部于剑突下有轻度压痛 ,但未见胃肠型。Ｘ线钡餐检查 :大量服钡后可见胃窦区有多个直径为 1ｃｍ大小的圆形或纺锤形的充盈缺损 ,其边缘光滑完整 ,其中心部未见着钡现象。斜位观察其与胃壁分界清晰 ,胃窦区加压后可见有数个缺损向大弯侧滚动 ,活动范围较大 ,并且十二指肠球内可见大量充盈缺损 ,并可见明显的后壁龛影 (图 1)。Ｘ线诊断 :①胃石症 ,②十…     

十二指肠单发性充盈缺损的X线诊断(附20例分析)

本文报道20例X线钡餐造影显示十二指肠单发性充盈缺损,经手术及病理证实为异位胰腺2例,结石2例,囊肿1例,腺瘤12例,腺癌3例。其共同的X线表现为单发性圆形或椭圆形充盈缺损,缺损边缘表现常不同,可为光滑、波浪状或不规则。对各类疾病的X线特征及鉴别诊断进行了分析讨论。     

胃同时性双重癌一例报告

患者男，75岁。因进行性吞咽困难20余天收入院。消化道钡餐检查贲门钡剂通过受阻，责门管壁僵硬，粘膜皱袭中断，食道下端略扩张．胃底小弯侧示充盈缺损。胃窦大弯侧亦见充盈缺损，壁僵硬。诊断：责门癌侵入胃底小奇及胃体大弯，胃体大奇侧淋巴结转移不能排除（图1，2）。胃纤维镜检查结果：贲门腺癌。手术与病理：行全胃切除，食道与空肠吻合。病理：贲门处有一大小的6X10X12cm＄样肿物偏向小弯侧。幽门前区有一大小约2X5X7cm。溃疡型肿物，偏向大弯例，两肿物之间相隔scm，粘膜未见异常。镜检：贲门区肿物癌细胞呈立方状或柱状，核大深…     

胃壁内憩室

X 线胃肠检查中胃贲门附近胃壁薄弱而形成的尖形憩室发生率约0.05%,而胃壁内憩室与贲门憩室虽有相同的发病率,但大多数胃壁内憩室都因不认识而被错误解释,故至1976年,仅有9例文献报道。作者报道一25岁病例,因肥胖病而手术,术前胃肠检查时发现胃窦部幽门前3厘米大弯侧有一边缘光滑的扁豆状囊袋阴影,其大小易变,开口处由环形壁组成,而胃粘膜皱襞正常,后经内窥镜证实为胃壁内憩室。手术时发现胃窦相应部位有一直径1.5厘米大小的胃壁变硬区域。     

大网膜脂肪沉积过多引起胃窦狭窄一例报告

女,68岁。胃脘不适伴反酸两年余,呕吐两周入院。既往无呕血及黑便史。体检,一般情况尚可。腹平坦。剑突下有压痛,未扪及明显包块。 X线钡餐检查,见胃体积稍大,胃窦大弯侧局限性偏心性狭窄,但胃壁柔软,有小蠕动波通过,邻近透亮度增高。对应之小弯侧平直,似僵丽不硬(图1)。于仰卧位示病变区粘膜尚规整,未见溃疡及充盈缺损征象(图2)。该处有压痛,扪之似有软组织增厚感,其界限不清,质地软,重压时又觉不明显。十二指肠各段未见异常。 X线诊断:胃窦部良性狭窄,恶性病变待排除。     

Heterotopic pancreas in the stomach: CT findings

PURPOSE: To describe the computed tomographic (CT) findings of heterotopic pancreas in the stomach. MATERIALS AND METHODS: CT findings in 12 patients with heterotopic pancreas in the stomach were reviewed. Surgical resection (n = 11) or endoscopic excision (n = 1) was performed in cases of symptomatic heterotopic pancreas (n = 4), suspected submucosal tumors (n = 7), and gastric carcinoma (n = 1). Seven patients underwent helical CT with water as an oral contrast agent; five underwent nonhelical CT with water-soluble contrast material. RESULTS: Nine heterotopic pancreata were in the antrum and one each was in the body, fundus, and perigastric fat. Seven lesions were on the greater curvature aspect; five, on the lesser curvature aspect. Common CT findings were well-defined oval or round masses with smooth or serrated margins in the gastric antral wall. Four of the seven lesions in which helical CT was performed enhanced similarly to normal pancreas. Preoperatively, CT depicted 11 of the 12 lesions, but CT findings were interpreted correctly as heterotopic pancreas in only two; the remaining 10 were misinterpreted as other lesions. Atypical findings were cystic dilatation of heterotopic pancreatic duct in two, unusual location in the fundus or perigastric fat in two, and malignant transformation in one. CONCLUSION: CT findings of heterotopic pancreas in the stomach appear to be nonspecific for diagnosis, except for location.     

胃憩室的MSCT诊断及误诊分析

目的 探讨胃憩室的MSCT表现及其误诊原因.方法 回顾性分析经手术病理、胃镜和钡餐检查联合证实的11例胃憩室患者的临床和影像资料,观察胃憩室的部位、密度、大小,对其MSCT诊断结果和误诊原因进行探讨.结果 胃憩室的发生部位：胃窦小弯侧1例,胃底10例,后者又包括左侧肾上腺区3例,胰腺尾部1例,靠近贲门2例,胃底大弯侧3例,胃底小弯侧1例.胃憩室的密度：囊性密度3例,液气囊1例,内容物密度6例,另1例做了多种对比剂检查,既有高密度混杂对比剂密度,又有液气囊密度.胃憩室的大小：6例在1～2 cm之间,长径大于2cm者3例,短径小于1cm者2例.11例胃憩室的MSCT诊断中,误诊左侧肾上腺肿瘤2例;误诊胰腺占位1例;漏诊和提示诊断各4例.结论 提高有关胃憩室相关知识的认识,有助于MSCT对其做出正确诊断.     

Computed tomographic recognition of gastric varices

The computed tomographic (CT) findings in 13 consecutive patients with proven gastric varices were analyzed and correlated with the radiographic, angiographic, and gastroscopic evaluations. In 11 patients, CT clearly identified large (five) or smaller (six) varices located mainly along the posteromedial wall of the gastric fundus and proximal body of the stomach. Well defined rounded or tubular densities that enhanced during intravenous administration of contrast material and could not be distinguished from the gastric wall were identified. Dense, enhancing, round or tubular, intraluminal filling defects were seen in the cases where the stomach was distended with water. In two patients, the CT diagnosis of gastric varices could not be confidently made. All patients had associated intraabdominal collateral circulation, situated medial to the stomach within the lesser omentum, along the distribution of the coronary venous system. In seven patients, the CT examination correctly diagnosed the pathogenesis of gastric varices by identifying hepatic cirrhosis, calcific pancreatitis, and carcinoma of the pancreas.     

食管憩室并食管及贲门癌的X线诊断价值

目的：探讨X线钡餐造影对食管憩室并食管及贲门癌的诊断价值。方法：回顾性分析18例经X线钡餐检查、纤维内镜和手术病理证实的食管憩室并食管、贲门癌的X线表现。结果：18例中,单发憩室15例,多发憩室3例,其中最多1例有5个憩室。3个有液气平面。11例食管憩室位于肿瘤之上,7例憩室与肿瘤重叠。食管癌15例,贲门癌3例。憩室X线表现为囊袋状或尖角状钡影突出,肿瘤处黏膜不规则中断破坏、不规则充盈缺损及龛影形成,管腔狭窄,管壁僵硬,扩张度差,对比剂通过缓慢。结论：X线钡餐检查是诊断食管憩室并食管癌、贲门癌最简单、可靠、安全的方法,并能为内镜提供准确的定位,避免憩室穿孔危险。     

残胃癌的X线早期诊断

目的:分析残胃癌在胃钡餐低张双重造影检查中的X线诊断价值及早期X线表现。方法:回顾性分析16例残胃癌的发病率,临床症状和X线表现。结果:残胃癌早期缺乏特异性,主要表现为上腹部隐痛不适,X线检查表现为充盈缺损,吻合口癌性浸润狭窄,残胃狭窄段呈皮革样。结论:术后五年,定期选用低张双重钡餐检查及胃镜检查是早期诊断残胃癌的关键。     

The need for using fluoroscopic guidance to obtain gastric biopsies when in search of Helicobacter pylori with a nonendoscopic method

PURPOSE: Nonendoscopic, fluoroscopic biopsy of the gastric mucosa, following barium examination of the stomach, has gained attention with its ease of performance and cost savings potential over endoscopy. Endoscopic research concerning the efficacy of biopsy sites has revealed an increased sensitivity of antral biopsies over greater curvature biopsies for the detection of Helicobacter pylori. Fluoroscopically guided biopsies of the gastric mucosal are studied to determine whether such a difference between site sensitivity held true. If not, blind biopsy through a nasogastric tube, which traditionally samples only the greater curvature, might prove an even less expensive alternative. MATERIALS AND METHODS: Seventy-two patients underwent nonendoscopic, fluoroscopically guided, mucosal biopsy of both the gastric antrum and the greater curvature of the stomach. Pathologic reports from both sites, using each patient as their own control, are compared to assess site sensitivity in the diagnosis of H. pylori gastritis. RESULTS: The sensitivity for the detection of H. pylori gastritis by antral biopsy is 89%, whereas the sensitivity of greater curvature biopsy is 62%, The difference is considered clinically significant at P < or = 0.05. CONCLUSIONS: This study confirms the need for antral biopsies when desiring a nonendoscopic approach to gastric mucosal sampling, in order to obtain a reasonable yield of data in dyspeptic patients with H. pylori gastritis. Blind techniques cannot reliably reach the antrum. Fluoroscopy can, and remains a less expensive alternative to endoscopy.     

胃食管石症的影像学诊断

目的探讨和总结胃、食管石症的X线及CT影像表现。方法15例胃、食管石症患者均行上消化道钡餐检查,其中2例行多层螺旋CT扫描。结果胃石症的X线表现为胃內移动性充盈缺损影,多为圆形或椭圆形,单发居多。充盈缺损块影表面可见条状、斑片状纵横交错的网状阴影,边缘呈锯齿状;透视下钡浆呈分流状,通过胃的两侧清楚地勾画出胃石的轮廓。CT检查胃石密度不均,表面毛糙呈颗粒状,居于管腔中央与管壁无粘连。结论胃、食管石症有较典型的影像学表现,认真分析总结可以提高诊断的准确率。     

早期胃癌X线表现与浸润深度相关性探讨

目的　探讨早期胃癌X线表现与浸润深度的关系。方法　总结了经胃肠气钡双重造影及手术病理证实的 19例早期胃癌X线表现 ,并与其浸润深度作了对照分析。结果　经手术证实的 19例中 ,黏膜内癌 9例 ,黏膜下癌 10例。黏膜内癌主要X线表现为胃壁舒张度减低 ,轮廓线模糊 ,胃小区增大 ,出现大小不等的颗粒样阴影 ,胃小沟模糊紊乱 ,似石榴籽样 ;黏膜下癌主要X线表现为胃壁僵直 ,局部密度增高 ,有小的充盈缺损 ,不规则形龛影 ,局部黏膜皱襞粗大、僵直、中断 ,胃小区小沟破坏。早期胃癌有功能性的改变 :异常收缩 ,滞留液增多。结论　胃肠气钡双重造影对早期胃癌的浸润深度有一定的诊断价值     

Hypertrophied antral-pyloric fold: reassessment of radiographic findings in 40 patients.

PURPOSE: To reassess the findings of a hypertrophied antral-pyloric fold on double-contrast barium studies. MATERIALS AND METHODS: A search of radiologic files resulted in recovery of records of 1,796 patients with findings of antral gastritis on double-contrast upper gastrointestinal studies. According to radiologic reports, 40 patients had a hypertrophied antral-pyloric fold. The radiographs were reviewed retrospectively to determine the size, location, and morphologic features of the folds. Clinical, radiologic, and/or endoscopic follow-up data were obtained in 22 patients. RESULTS: All but two patients were symptomatic, and all but one responded to medical treatment. The hypertrophied antral-pyloric fold was located on the lesser curvature of the distal antrum in all patients and extended to the pylorus in 25 (62%) and into the base of the duodenal bulb in 15 (38%). The fold appeared as a smooth or slightly lobulated submucosal mass in 37 (92%) patients and as a plaquelike lesion in three (8%). Other radiographic findings of antral gastritis were present in 26 (65%) patients. In nine patients who underwent endoscopy, endoscopic and/or histologic findings of antral gastritis were present in five, but none had evidence of tumor. CONCLUSION: A hypertrophied antral-pyloric fold may be a sign of antral gastritis that is associated with characteristic radiographic findings. Endoscopy and biopsy may not be warranted when lesions with features typical of a hypertrophied antral-pyloric fold are seen on double-contrast barium studies.     

Malignant pyloric stenosis caused by cancer in para-pyloric ectopic pancreas

Gastrointestinal symptoms with epigastric pain, nausea and loss in weight occasionally occur in patients with ectopic pancreas. Although ectopic pancreas is often found in the stomach, carcinoma in this ectopy is rare. This paper reports a case of pancreatic carcinoma arising in ectopic pancreas located in the gastric wall and causing pyloric obstruction. Malignant pyloric obstruction was the only radiographic sign. Microscopic examination led to the final diagnosis.