单气囊小肠镜在小肠疾病中的应用

目的:分析单气囊小肠镜检查疑似小肠疾病的特点及临床应用价值。方法:114例疑似小肠疾病患者,行单气囊小肠镜检查,观察其进镜方式、进镜时间、患者的耐受性、疾病诊断、检出率及并发症的发生率。结果:共进行152次检查,经口进镜83例次,经肛进镜69例次;检出的小肠病变84例,检出率73.7%;单气囊小肠镜对不明原因消化道出血的检出率明显高于腹痛、腹泻待查等患者(P<0.05);检出疾病主要有肿瘤性病变、非特异性小肠炎、克隆恩病、肠结核、血管病变、淋巴瘤等。经口进镜时间明显短于经肛进镜(P<0.05);患者耐受性好,无并发症发生。结论:单气囊小肠镜是目前诊断小肠疾病的安全可靠方法。     

单气囊小肠镜对老年人小肠疾病的诊断价值

目的：评价单气囊小肠镜(single balloon enteroscopy, SBE)对老年人小肠疾病的诊断价值。方法对怀疑有小肠疾病的61例老年患者（男37例,女24例）在麻醉状态下行72例次(经口46例次,经肛26例次)SBE检查。与同期检查的345例非老年人进行比较。结果61例均能耐受检查,检出阳性率为62.3%（38/61）,SBE检查时间（55.93±14.39） min,插镜深度（197.6±101.2）cm。检出的主要病变有：小肠溃疡（8例）、小肠炎性改变（7例）、小肠癌（6例）、小肠憩室（5例）、小肠间质瘤（4例）、小肠血管扩张症（3例）。对3例患者行镜下治疗。与同期检查的非老年人比较,老年人小肠溃疡、小肠癌及血管扩张症的检出率较高（P＜0.05）。结论 SBE对老年人小肠疾病有较高的诊断率,是一种安全可靠的诊疗手段。     

难治性鼻出血的诊治

目的:探讨难治性鼻出血的出血部位及检查治疗方法.方法:对62例经2次以上常规填塞未能止血的难治性鼻出血患者进行回顾性分析.结果:出血部位依次为:下鼻道后段、嗅裂区、中鼻道后段、鼻中隔后缘、鼻咽静脉丛.62例患者中51例1次填塞成功,10例经2次填塞,1例填塞无效,后经动脉造影血管栓塞治疗.随诊1个月,无复发病例.结论:详细的纤维鼻咽镜或鼻内镜检查对探察鼻腔深部出血具有重要意义,是止血的关键.     

气囊辅助内镜在小肠肿瘤诊治中的应用价值

目的 研究气囊辅助内镜(BAE)在小肠肿瘤诊治中的应用价值.方法 收集我院2007年5月-2014年9月收治的126例临床疑似小肠肿瘤并行BAE检查的患者,其中80例患者同时行腹部CT检查,22例患者同时行消化道钡剂造影检查,24例患者同时行胶囊内镜检查.比较不同检查方法对小肠肿瘤阳性检出率、特异性、敏感性、漏诊率、误诊率等方面的差异.部分患者行BAE镜下治疗并评价其安全性及可行性.结果 BAE对于小肠肿瘤的阳性检出率为92.9％,明显高于腹部CT(47.5％)和消化道钡剂造影(68.2％),但与胶囊内镜(91.7％)比较差异无统计学意义(p＞0.05).BAE与胶囊内镜检查小肠肿瘤的敏感性均为100％,明显高于腹部CT(71.1％)和消化道钡剂造影(66.7％,P＜0.01).BAE检查小肠肿瘤的特异性为100％,明显高于腹部CT(82.9％)、消化道钡剂造影(28.6％)及胶囊内镜(22.2％,P＜0.01).BAE检查与胶囊内镜检查的漏诊率均为0,与腹部CT(28.9％)、消化道钡剂造影(33.3％)比较明显降低(P＜0.01).本组病例中,BAE检查未发现误诊病例,腹部CT误诊率为17.1％,消化道钡剂造影误诊率为71.4％,胶囊内镜误诊率为77.8％,BAE误诊率较腹部CT、消化道钡剂造影、胶囊内镜明显降低(P＜0.01).BAE可对部分小肠肿瘤患者进行镜下治疗.结论 BAE检查对小肠肿瘤具有较高的阳性检出率、敏感性及特异性,且对于部分小肠肿瘤的内镜下治疗安全、可靠,具有较高的临床应用价值.     

MRI在小肠疾病诊断中的应用价值

目的 探讨MRI在小肠疾病诊断中的可能性及其临床应用价值.方法 63例临床怀疑有小肠疾病的患者及3名志愿者进行了小肠MR平扫及对比增强T_1WI,并对肠管显示质量进行评分.将31例经手术或临床证实患者的MR影像诊断结果与临床最终诊断结果相比较,评价MRI诊断的敏感性与准确性;对肿瘤性与非肿瘤性病变肠壁的平均厚度进行Wilcoxon秩和检验,对两者的肠系膜肿大淋巴结、肠壁周围浸润及肠腔狭窄情况分别采用Fisher精确检验.结果 66例小肠MR检查均获得成功,图像质量达2分和3分者共62例,占93.9%(62/66).MR发现病变的敏感性为100%(31/31),诊断的准确率为77.4%(24/31).31例经手术或临床证实的患者中,肿瘤性病变10例,非肿瘤性病变21例,两者病变肠壁的平均厚度分别为23.0 mm(7.0～65.0 mm)及5.0 mm(2.0～35.0 mm),差异有统计学意义(Z=-2.949,P<0.01);周围肠系膜淋巴结肿大分别为7及4例,差异有统计学意义(P<0.05);肠腔狭窄均为10例,差异有统计学意义(P<0.01);病变周围的浸润性病变分别为5及17例,差异无统计学意义(P>0.05).结论 小肠MR检查安全可靠,能清楚地显示小肠病变的部位与范围,对病变定性诊断具有较高的准确性,是诊断小肠疾病的一种有效的检查方法.     

MRI在小肠疾病诊断中的应用价值

目的 探讨MRI在小肠疾病诊断中的可能性及其临床应用价值.方法 63例临床怀疑有小肠疾病的患者及3名志愿者进行了小肠MR平扫及对比增强T1WI,并对肠管显示质量进行评分.将31例经手术或临床证实患者的MR影像诊断结果与临床最终诊断结果相比较,评价MRI诊断的敏感性与准确性;对肿瘤性与非肿瘤性病变肠壁的平均厚度进行Wilcoxon秩和检验,对两者的肠系膜肿大淋巴结、肠壁周围浸润及肠腔狭窄情况分别采用Fisher精确检验.结果 66例小肠MR检查均获得成功,图像质量达2分和3分者共62例,占93.9%(62/66).MR发现病变的敏感性为100%(31/31),诊断的准确率为77.4%(24/31).31例经手术或临床证实的患者中,肿瘤性病变10例,非肿瘤性病变21例,两者病变肠壁的平均厚度分别为23.0 mm(7.0～65.0 mm)及5.0 mm(2.0～35.0 mm),差异有统计学意义(Z=-2.949,P<0.01);周围肠系膜淋巴结肿大分别为7及4例,差异有统计学意义(P<0.05);肠腔狭窄均为10例,差异有统计学意义(P<0.01);病变周围的浸润性病变分别为5及17例,差异无统计学意义(P>0.05).结论 小肠MR检查安全可靠,能清楚地显示小肠病变的部位与范围,对病变定性诊断具有较高的准确性,是诊断小肠疾病的一种有效的检查方法.     

双气囊小肠镜诊断小肠疾病294例分析

随着内镜技术的不断改进和发展，小肠镜已越来越多地运用于临床[1-2]。2001年，Yamamoto等率先报道了经双气囊小肠镜（DBE）进行全小肠检查。DBE可直视整个小肠黏膜并可对病灶活检明确病理性质，是小肠疾病检查的新手段。2009年5月-2012年10月，我们对疑诊小肠疾病294例行DBE检查，患者均耐受性良好。现分析报告如下。     

食管静脉曲张出血内镜下硬化治疗的临床应用

目的总结食管静脉曲张出血患者在内镜下采用改进静脉内注射法行硬化治疗的经验。方法对85例食管静脉曲张出血患者在内镜下采用改进静脉内注射法注射5%鱼肝油酸钠进行止血治疗。结果急诊内镜下硬化治疗55次,急诊止血成功53次,急诊止血成功率96.4%;非急诊内镜下硬化治疗176次;治疗结束后复查胃镜,静脉曲张消失44例,基本消失29例,消失和基本消失占85.9%。内镜下硬化治疗发生并发症9例(占10.6%);住院期间非内镜下硬化治疗发生并发症死亡5例(占5.9%)。治疗2周后复查胃镜42例(占49.4%)出现浅溃疡,经治疗后痊愈;治疗1个月后3例出现食道狭窄,经分次扩张后改善。结论在内镜下采用改进静脉内注射法注射5%鱼肝油酸钠是治疗食管静脉曲张出血的安全、有效、简便方法。     

原发性小肠肿瘤临床特点及其诊治探讨

目的分析原发性小肠肿瘤的临床特点,探讨其诊断与治疗方法。方法回顾性总结分析我院2007—2014年收治的80例原发性小肠肿瘤患者的临床特点、病理类型与诊治方法。结果 80例原发性小肠肿瘤患者以腹痛、消化道出血、贫血、肠梗阻、腹部包块、消瘦为主要临床表现。其中恶性肿瘤30例,病理类型以腺癌、恶性间质瘤、淋巴瘤、印戒细胞癌为主;良性肿瘤50例,病理类型依次为良性间质瘤、错构瘤、腺瘤、血管瘤、脂肪瘤。原发性小肠肿瘤多发生于空肠,其次为十二指肠、回肠、十二指肠与空肠交界处。气囊辅助内镜对小肠肿瘤的阳性检出率明显高于胶囊内镜、腹部CT和消化道钡剂造影检查(分别为97.5%、88.2%、68.8%、66.7%,P<0.01)。结论原发性小肠肿瘤临床表现无特异性。气囊辅助内镜在小肠肿瘤的诊断和治疗中具有重要的临床应用价值。联合应用气囊辅助内镜、胶囊内镜、腹部CT及消化道钡剂造影检查可明显提高小肠肿瘤确诊率。     

气囊辅助内镜对小肠憩室的诊断价值及其对治疗的指导意义

目的分析小肠憩室的临床特点,探讨气囊辅助内镜(balloon-assisted enteroscopy,BAE)对于小肠憩室的诊断价值及其对治疗的指导意义。方法纳入2006年12月—2014年7月空军总医院消化内科收治行BAE检查确诊的小肠憩室53例,对患者一般情况、病变部位、临床表现、诊断情况、治疗方法等进行回顾性分析。结果 53例中,BAE确诊十二指肠水平部近空肠段憩室8例(15.09%),Meckel憩室29例(54.72%),其他空回肠憩室16例(30.19%),多发憩室5例,单发憩室48例。临床表现中消化道出血发生率为86.79%(46/53),腹痛、腹泻发生率为26.42%(14/53),贫血发生率为88.68%(47/53)。30例行外科手术治疗。结论 BAE对小肠憩室具有较高的诊断价值,并可为临床治疗提供依据。     

The value of the per oral pneumocolon in the study of the distal ileal loops

AIM: To verify the diagnostic accuracy of per oral pneumocolon in the identification of both normal and pathological patterns in patients with suspected or proven small bowel disease. MATERIALS AND METHODS: Per oral pneumocolon was performed after small bowel follow-through examinations in a series of 42 selected patients. The terminal ileum visibility, the loop location and possible pathological patterns were evaluated separately before and after insufflation. In post-insufflation images the presence/absence of reflux and grade of reflux were evaluated. RESULTS: The diagnostic quality of per oral pneumocolon as compared with per oral small bowel examination was superior in 23 of the 42 patients (54.8%; group 1), similar in nine of the 42 (21.4%; group 2), and inferior in 10 of the 42 (23.8%; group 3). Transvalvular reflux was present in 22 of 23 (95.6%) patients from group 1 and only in one of 10 patients (10%) from group 3 (p<0.001: statistically significant difference). Among the 24 of 42 (57.1%) patients with suspected or proven Crohn's disease, per oral pneumocolon increased the confidence with which the ileum was considered normal in 12 patients and it allowed a better evaluation of the disease extent and the differentiation between prolonged spasms and stenosis in five patients. CONCLUSION: In conclusion per oral pneumocolon should be performed after a small bowel follow-through examination in selected patients.     

Ct evaluation of small bowel obstruction.

Although small bowel obstruction is a common occurrence, it is essential that this clinical condition be treated properly, that the site, level, and cause of obstruction be determined accurately, and that a tentative prognosis be formulated prior to surgery. The diagnosis of small bowel obstruction is based on a comprehensive approach that includes clinical background, patient history, and results of physical examination and laboratory tests. A variety of radiologic procedures are available to aid in the diagnosis of small bowel obstruction. Recent studies have demonstrated the superiority of CT in revealing the site, level, and cause of obstruction and in demonstrating threatening signs of bowel inviability. CT has proved useful in characterizing small bowel obstruction from extrinsic causes (adhesions, closed loop, strangulation, hernia, extrinsic masses), intrinsic causes (adenocarcinoma, Crohn disease, tuberculosis, radiation enteropathy, intramural hemorrhage, intussusception), intraluminal causes (eg, bezoars), or intestinal malrotation. Conventional radiography was the modality of choice for many years and should remain the initial imaging method in patients with suspected small bowel obstruction. However, the unique capabilities of CT in this setting make this modality an important additional diagnostic tool when specific disease management issues must be addressed.     

Multidetector CT of the small bowel: evaluation after oral hyperhydration with isotonic solution

PURPOSE: The aim of our study was to assess the diagnostic capabilities of multidetector CT in the evaluation of the small bowel in different pathological conditions, with the use of oral hyperhydration with isotonic solution. MATERIALS AND METHODS: The study retrospectively evaluated 106 patients who underwent multidetector CT of the small bowel. Four groups were considered on the basis of the clinical findings: group A (48 cases), with suspected or certain chronic inflammatory disease of the small bowel; group B (16 cases), with suspected neoplastic lesion of the small bowel; group C (17 cases), patients affected by malabsorption; group D (25 cases), others: 13 cases with non-specific abdominal pain, 4 cases with occult bleeding, 8 cases affected by fever of unknown origin. Thirteen patients had previously undergone surgical intestinal resection. In all cases the CT examination was performed after the oral administration of 2000 mL polyethylene glycol electrolyte balanced solution; before the scan, N-butyl scopolamine or glucagon were administered intravenously to obtain rapid inhibition of bowel peristalsis. All multidetector CT scans were acquired at baseline and 50 seconds after the I.V. administration of 110-130 ml high-concentration non-ionic iodinated contrast medium. The images were subsequently processed on a dedicated workstation (Advantage Windows 4.0, GE Medical Systems) to obtain multiplanar reconstruction (MPR). We considered the following CT findings: fold distribution, wall thickening and stratification and contrast enhancement, extraparietal involvement and abnormalities of the abdominal organs. The CT diagnoses were compared with the clinical and laboratory findings (86 cases) and with the results of barium follow-through (55 cases), ileo-colonoscopy (45 cases) or surgery (28 cases). RESULTS: CT examination allowed the correct diagnosis in 86/106 cases (89%); 20 patients were not included in the study because of a poor (11 cases) or absent (9 cases) small bowel loop distension. The final diagnoses in the 86 patients were: Crohn's disease of the small bowel (38 cases), Crohn's disease of the duodenum (1 case), granulomatous colitis (3 cases), malabsorption (8 cases), neoplastic lesion (4 cases), post-radiation conglomeration of ileal loops (1 case), intestinal lymphangiectasia (1 case), ulceration of the last ileal loop (1 case). In 29 cases no abnormalities of the small bowel were found. Spiral CT yielded 52 true positive cases, 5 false negative cases, 2 false positive cases, and 27 true negative RESULTS: The sensitivity of the technique was 91%, specificity 93% and diagnostic accuracy 92%. CONCLUSIONS: Multidetector CT of the small bowel performed after oral hyperhydration with isosmotic solution, proved to be an accurate and thorough technique. It can be considered a safe and effective alternative to conventional radiographic studies and to small bowel spiral CT enema in patients that refuse the nasojejunal balloon catheter or the administration of methylcellulose.     

Usefulness of MR Imaging for Diseases of the Small Intestine: Comparison with CT

Objective

To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT.

Materials and Methods

Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared.

Results

MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients.

Conclusion

MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction.     

口服法小肠灌肠CT检查的诊断价值研究

目的：评价口服法小肠灌肠CT检查对小肠病变的诊断价值。材料和方法：研究的对象包括2003年1月-2005年3月间53例临床怀疑有小肠病变而行小肠CT检查的患者。扫描前20—30rain口服混合溶液（每1000ml由20％甘露醇250ml＋5％糖盐水500ml＋水250ml所配成）约2000ml充盈小肠。首先，对小肠的扩张程度进行评价；其次，通过横断位及多平面重建，从局限性或弥漫性肠壁增厚、小肠肿块、小肠系膜扭转、肠系膜淋巴结肿大、远处转移几方面进行征象分析，并作出诊断。分别计算小肠CT检查的敏感度、特异度、阳性预测值和阴性预测值。结果：小肠扩张最佳的24例（24／53），扩张良好的25例（25／53），扩张欠佳的4例（4／53），无扩张0例（0／53）；口服肠道准备小肠CT检查的敏感度为97．6％（40／41），特异度为75％（9／12），阳性预测值为93．0％（40／43），阴性预测值为90．0％（9／10）。结论：口服肠道准备小肠螺旋CT检查方能够很好满足诊断需要，对小肠病变具有诊断价值。     

Non-traumatic acute bowel disease: differential diagnosis with 64-row MDCT

To evaluate the role of 64-row multidetector computed tomography (MDCT) in the differential diagnosis of non-traumatic acute bowel disease. We retrospectively reviewed CT findings of 57 patients (29 men and 28 women; mean age, 65.5 years, range 19–99) who presented to our institutions with symptoms of acute abdomen. All patients underwent MDCT. MDCT diagnosis was compared with surgical findings and histological examinations. A total concordance between the MDCT findings and discharge diagnosis (based on surgical findings and histological examinations) was found in 47/57 cases (82.4%); partial discordance was seen in 10 of 57 cases (17.5%) and discordance in 0 of 57 (0%) cases. The overall sensitivity of MDCT was 82.4%. MDCT is a very reliable method in the diagnostic management of non-traumatic acute bowel diseases allowing a fast and precise differential diagnosis and therefore a timely treatment.     

多层螺旋CT肠道成像的临床研究

目的 探讨口服2.5%等渗甘露醇多层螺旋CT肠道成像(MSCTE)的优势及其临床价值.方法 40例临床怀疑为小肠肿瘤疾病者采用完全随机法分为2组,分别行常规法与改良法CT小肠MSCTE,对比2种方法观察6段小肠(1段为十二指肠,2段为空肠近段,3段为空肠远段,4、5、6段为回肠)的管腔扩张度及管壁厚度.20例临床怀疑胃肠道疾病患者行全胃肠CT成像检查.对胃肠道管腔扩张度评分及管壁厚度采用x2检验和t检验进行比较.结果 胃、回肠及各组大肠肠壁厚度分别为(2.56±0.52)、(1.41±0.15)、(1.46±0.13)、(1.91±0.25)、(1.97±0.26)、(2.01±0.19)、(2.04±0.24)和(2.05±0.18)mm.改良法MSCTE对2、3段(空肠近段和远段)小肠肠壁、肠腔及黏膜皱襞的显示效果明显优于常规法(P值均＜0.05),2种方法对1、4、5、6组(十二指肠和回肠)小肠肠壁、肠腔及黏膜皱襞的显示效果差异无统计学意义(P值均＞0.05).全胃肠CT成像对十二指肠及空肠充盈稍差,胃、回肠及大肠均充分充盈,胃肠道管腔、管壁及黏膜皱襞显示清晰.结论 改良法小肠MSCTE对空肠充盈效果更好,全胃肠CT成像能一次性使胃、小肠及大肠均较好的充盈,拓展了MSCTE的诊断范围.

Abstract：

Objective To investigate the value and usefulness of optimized multislice CT enterography (MSCTE) with orally administered isosmotic mannitol (2. 5%) as negative contrast in demonstrating the small bowel and its abnormality. Methods Forty patients suspected of intestinal tumors were randomly divided into two groups and underwent conventional or optimized MSCTE. The expansion degree of bowel lumen and the thickness of bowel wall were evaluated for the six segments of the small intestine. The other 20 patients suspected of gastrointestinal diseases underwent gastrointestinal CT imaging.The expansion degree of bowel lumen and the wall thickness of bowel wall were statistically analyzed with Chi-Square test and t test. Results The wall thickness of the stomach, ileum and colon were (2. 56 ±0.52) ,(1.41 ±0. 15),(1.46 ±0. 13),(1.91 ±0. 25), (1.97 ±0.26),(2.01 ±0. 19), (2. 04 ±0.24)and (2. 05 ±0. 18)mm. Optimized method was superior to conventional method in the expansion degree of the second and third segments of the small intestine (P ＜ 0. 05) . There was no significant differences between two groups in the expansion degree and depiction of mucosa for the other segments of small intestine (P ＞ 0. 05). The gastrointestinal CT imaging was poor in the depiction of the duodenum and jejunum, but stomach, ileum and colon were fully illustrated. Conclusion Optimized MSCTE was superior to conventional method in demonstrating the small bowel, and gastrointestinal CT imaging can expand diagnostic scope because of good observation of whole gastrointestinal tract.     

Intestinal accumulation of 111In-granulocytes in patients studied because of occult infection

¹¹¹In-granulocyte scintigraphy was performed on 245 patients in whom a localized infection was suspected. In 123 patients scintigraphy was positive and of these 35 (28%) had intestinal accumulations of ¹¹¹In-granulocytes. Specific local causes for the intestinal uptake of radioactivity were antibiotic associated colitis (eight patients), local pyogenic bowel infection (four patients), systemic disease (two patients), bowel necrosis (two patients), colonic cancer (one patient) and Stevens-Johnson's syndrome (one patient). Nonspecific mechanisms of bowel accumulation were desquamation of labelled granulocytes (12 patients) and bleeding (two patients). In three cases the mechanism of colonic accumulation of granulocytes was not revealed. These results show that unexpected accumulations of labelled granulocytes in the gut is not a rare phenomenon and is often due to clinically significant intestinal inflammation or other disease, especially in patients who do not have signs of respiratory, pancreatic or oesophageal inflammation causing desquamated granulocytes to accumulate in the gut.     

小肠磁共振水成像检查方法及其诊断价值

目的探讨小肠磁共振水成像检查方法及其对小肠疾病的诊断价值。方法本组28例小肠磁共振水成像。25例检查前30min口服0.9%氯化钠注射液或5%葡萄糖氯化钠注射液1500ml,检查前10min静脉注射山莨菪碱20mg;3例小肠梗阻直接进行小肠磁共振水成像,6例增强扫描。诊断结果与插管法小肠气钡造影结果对照。部分病例经手术、病理证实。结果28例小肠磁共振水成像检查均获得成功,图像质量满足诊断要求。正常小肠10例,Crohn’s病2例,十二指肠乳头癌3例,十二指肠腺瘤样增生1例,十二指肠憩室2例,小肠腺癌3例,回肠息肉1例,空肠间质瘤2例,回肠梗阻3例,小肠系膜扭转1例。18例小肠器质性病变诊断敏感性100%(18/18),特异性77.8%(14/18)。结论磁共振水成像对小肠病变的诊断是一种有效的检查方法。