同时性多原发结肠癌误诊三例临床分析

目的探讨同时性多原发结肠癌的临床特点及误诊原因。方法回顾性分析同时性多原发结肠癌误诊3例的临床资料。结果例1因大便带血1个月就诊,经肠镜、下消化道钡剂造影等检查诊断为乙状结肠癌后行手术治疗,1个月后复查癌胚抗原78.5μg/L,行正电子发射型计算机断层扫描(PET/CT)、肠镜及活组织病理检查诊断横结肠癌,再次手术治疗。例2因黏液样便、血便1个月就诊,外院肠镜发现降结肠与回盲部两处病灶,我院复查肠镜未能通过降结肠病灶达盲肠,疑诊升结肠癌,经手术探查及术后病理确诊为同时性多原发结肠癌。例3因大便带血2个月就诊,外院肠镜检查疑诊为乙状结肠单原发结肠癌,我院肠镜检查证实结肠存在3处占位性病灶,经手术及术后病理确诊为同时性多原发结肠癌。3例术后定期门诊复查均未发现肿瘤复发。结论同时性多原发结肠癌临床表现不典型,极易误漏诊。临床医师需加强对同时性多原发结肠癌的认识,对疑诊患者需完善CT、下消化道钡剂造影及PET/CT等检查,必要时再次行肠镜检查,可提高术前诊断率。     

320排螺旋CT结合仿真内镜在结直肠癌中的诊断价值

目的：探讨320排螺旋CT结合仿真内镜方式在结直肠癌临床诊断中的应用价值。方法：选取2021年3月—2022年3月广东省中医院收治的59例结直肠癌疾病患者,所有患者均采取320排螺旋CT结合仿真内镜进行诊断。以病理结果为金标准,探讨CT仿真内镜诊断对于结直肠癌疾病的临床诊断价值。结果：320排螺旋CT结合仿真内镜与病理结果在病变类型（肿瘤与息肉）与病变位置（直肠癌、升结肠癌、降结肠癌、乙状结肠癌以及横结肠癌）检查结果一致,转移情况（未见转移、淋巴结转移以及外周脂肪浸润）的检查准确率对比,差异无统计学意义（P> 0.05）。结论：320排螺旋CT结合仿真内镜可以明确结直肠癌疾病病变类型、病变位置以及转移情况,具有较高的临床诊断价值与实用价值,值得临床推广应用。     

重复癌3例报告并文献复习

目的 进一步提高影像学技术对重复癌诊断重要性的认识。方法 报道3例重复癌的病例及影像表现并复习相关文献加以分析和讨论。结果 3例重复癌患者，有2例同时性双重癌，分别患升结肠癌及直肠癌和结肠肝曲癌及降结肠癌，1例为异时性三重癌，患有胃癌、肺癌、横结肠癌。术前大部经影像学检查诊断明确，仅一个部位未做影像检查，经肠镜明确，均经手术病理证实。结论 重复癌并不少见，发病率逐渐增高，影像学技术对于重复癌的诊断有很大价值。     

结肠病变多排螺旋CT表现及误漏诊原因分析

目的总结结肠病变多排螺旋CT表现及导致误诊漏诊的原因。方法我院2015年1月至2016年4月收治的行急诊多排螺旋CT检查发生漏诊误诊的11例结肠病变患者,均应用Aquilion One 320排螺旋CT机进行检查。以手术病理或活检结果为金标准对结肠病变患者的多排螺旋CT表现进行总结并分析引起患者误诊与漏诊的原因,总结不同类型结肠病变的鉴别要点。结果 11例患者中5例漏诊患者,后经手术病理证实为2例直肠腺癌、2例升结肠腺癌及1例乙状结肠腺癌;6例误诊患者,1例阑尾黏液囊肿误诊为右侧卵巢囊腺癌,1例直肠回盲部溃疡性中分化腺癌误诊为炎性病变,1例乙状结肠淋巴瘤误诊为间质瘤,1例肠痉挛和1例结肠息肉误诊为结肠癌、1例炎性病变误诊为直肠癌。结论 320排螺旋CT检查在结肠病变患者的临床诊断中有较大应用价值,而各项肠道清洁准备工作与扫描前结肠充气对患者扫描结果有较大影响,需引起重视并积极对不同结肠病变的鉴别诊断要点进行总结,以最大限度降低误诊与漏诊的可控因素,提高临床诊断准确性。     

肠镜检查直肠病变漏诊12例分析

目的：分析纤维肠镜检查中有直肠病变漏诊的原因。方法：对12例已做纤维肠镜检查的患者进行肛门指诊，直肠镜检查发现病变，经病理检查确诊，从而发现漏诊。结果：12例漏诊患者中直肠癌2例，直肠腺瘤5例，直肠炎性息肉2例，直怕炎3例，结论：通过对12例直肠病变漏诊分析，要求检查者必须严格按照操作规范进行操作，加强工作责任心，提高技术水平，注意医患良好合作，从而杜绝漏诊发生。     

多层螺旋CT仿真肠镜在结直肠癌诊断中的临床应用

目的：探讨64排螺旋CT仿真肠镜在结直肠癌诊断中的价值。方法回顾分析56例结直肠癌病例的影像资料、临床结果、手术及病理结果。结果本组病理诊断56例结直肠癌,CT诊断52例,诊断符合率92.9％（52/56）,定位诊断符合率100％。8例患者合并结肠息肉,5例为多发,共发现结肠息肉14枚。病变侵及结肠浆膜层12例,腹盆腔淋巴结转移9例,肝多发转移5例,腹膜转移4例。多层螺旋CT能对临床分期做出准确评估。结论 CT仿真肠镜可准确显示结直肠恶性病变的大小、形态、边缘及肠壁侵犯情况,有利于准确的临床分期,为治疗方案的确定提供重要参考。     

放大肠镜在结直肠平坦型病变诊治中的应用

目的 探讨放大肠镜在结直肠平坦型病变中的诊断及治疗价值.方法 对87例结直肠平坦型病变患者进行黏膜染色后的放大观察,按工藤( KUDO)分型对腺管开口进行分型诊断,同步对病变行内镜下黏膜切除术(EMR),标本送病理检查,将内镜诊断结果与病理诊断结果相比较.结果 共检出结直肠平坦型病变87例,其中炎性病变27例,增生性病变13例,管状腺瘤13例,绒毛状腺瘤24例,混合型腺瘤6例,结肠癌4例.非肿瘤性痛变腺管开口以Ⅰ、Ⅱ型为主,瘤性病变以Ⅲ、Ⅳ、Ⅴ型为主,其中ⅤA常为早期癌,ⅤN为浸润癌.对病变行内镜下黏膜切除术后未有出血穿孔等并发症发生.结论 通过放大肠镜观察结直肠平坦型病变的腺管开口,对于判断瘤性、非瘤性病变具有重要意义,利用内镜可以完成对大部分病变的同步、微创治疗.     

螺旋CT仿真结肠内镜的临床应用研究

目的　探讨螺旋CT仿真结肠内镜对结、直肠病变的检查方法及诊断价值。方法　采用螺旋CT机行 2 8例腹盆部扫描 ,并对图像行三维仿真结肠内镜重建。结果　正常 3例 ,直肠息肉 4例 ,结、直肠癌 11例 (2例为阻塞型 )。病理结果为正常 2例 ,直肠息肉 3例 ,结、直肠癌 13例 ,符合率 88.9%。结论　螺旋CT仿真结肠内镜是一种易操作的无创性检查方法 ,对结肠及直肠息肉、肿瘤等病变有很大诊断价值 ,可在术前提供重要信息。     

低张直肠水灌肠多层螺旋CT检查诊断直肠癌的价值

目的 探讨低张直肠水灌肠多层螺旋CT在直肠癌CT表现及诊断价值。方法 肌注山莨菪碱（645-2）20mg后，直肠灌注温生理盐水进行CT扫描，分析经肠镜取材病理证实及手术证实的25例直肠癌资料。结果 多层螺旋CT显示肿瘤部准确率100％，低张直肠水灌肠多层螺旋CT可见病变肠壁增厚、突出腔内的肿块、肠腔狭窄及浆膜面毛糙，可见直肠癌侵犯邻近器官及远处转移。结论 低张直肠水灌肠多层螺旋CT检查对直肠癌的术前诊断有很大价值。扫描前良好的肠道准备及扫描方法是多层螺旋CT对直肠癌诊断及分期的关键。     

452例大肠癌的内镜及病理分析

目的：探讨大肠癌近年来的发病情况、病理特点及诊断方法。方法：回顾性分析近5年来452例大肠癌的临床、肠镜及病理资料。结果452例大肠癌中，男276例，女176例，男女之比为1．57：1．00。结肠癌230例，直肠癌222例，结直肠癌之比为1．04：1．00，横结肠癌70例，乙状结肠癌50例，升结肠及盲肠癌47例，肝曲30例。病理为腺癌345例，黏液腺癌47例，低分化腺癌35例。结论：近年来大肠癌发病趋上升，男性发病比女性多，直肠癌与结肠癌发病接近。结肠癌近年发病增加且超过直肠癌，男性以横结肠及近肝曲为主，女性以乙状结肠为主。距肛门5cm以上直肠癌较5cm以下为多。病理仍以腺癌为主。加强对高危人群的普查和肠镜检查，可提高大肠癌的早期诊断。     

低剂量CT仿真结肠镜结合增强扫描对结直肠疾病的诊断价值

目的:评估低剂量CT仿真结肠镜结合增强扫描对结直肠疾病的诊断价值。方法:对104例受检者进行低剂量CT仿真结肠镜及增强扫描检查,将检查结果与结肠镜活检病理结果进行比较,计算低剂量CT仿真结肠镜诊断病变的敏感度和特异度,并分别记录低剂量和常规剂量扫描的CT容积剂量指数(CT dose index volume,CTDI vol)。结果:104例受检者中,阳性病变者91例,阴性13例。其中低剂量CT仿真结肠镜检出阳性者89例(89/91,97.8%),低剂量CT的CT辐射指数较常规CT平均降低60.59%。与常规剂量CT相比,低剂量CT仿真结肠镜对肠壁浸润程度、病变定性及腹膜后淋巴结的显示均稍差,而增强扫描有助于弥补这些不足。结论:低剂量CT仿真结肠镜检查可以有效地发现结直肠病变,且较常规CT的X线辐射剂量低;增强扫描适用于结直肠癌术前分期,低剂量CT仿真结肠镜结合增强扫描对结直肠疾病的诊断有较高价值。     

Comparison of CT colonography vs. conventional colonoscopy in mapping the segmental location of colon cancer before surgery

Once presence of a colorectal cancer has been diagnosed, a key factor for patient's prognosis in view of surgical intervention is the correct segmental localization and resection of the tumor. The aim of this work was to compare the accuracy of the current gold standard technique, conventional colonoscopy (CC), to computed tomography colonography (CTC) in the segmental localization of tumor. Sixty-five patients (mean age 64; 45 female and 19 male) with colorectal cancer diagnosed at colonoscopy underwent CTC before surgery. In 45 out of 65 cases (69%), patients were referred to CTC after incomplete CC. Reasons were patient intolerance to CC or presence of stenosing cancer, with consistent difficulties in crossing the tract of the colon involved by the lesion. CTC allowed the complete colonic examination in 63/65 cases, since in 2 patients with an obstructing lesion of the sigmoid colon, pneumocolon could not be obtained. However, per patient and per lesion sensitivity of CTC was 100%. Difference from colonoscopy was statistically significant (P < 0.05). In terms of segmental localization of masses, CTC located precisely all lesions, while colonoscopy failed in 16/67 (24%) lesions, though six were missed for incomplete colonoscopy (9%). In the remaining 10/67 (15%) lesions, detected by colonoscopy but incorrectly located, the mismatch occurred in the rectum (n = 3), sigmoid (n = 2), descending (n = 1), transverse (n = 2), ascending colon, and cecum. Agreement between CTC and CC was fair (k value 0.62). Sensitivity, specificity, positive predictive value and negative predictive value of CTC in determining the precise location of colonic masses were respectively 100%, 96%, 85%, and 100%. CT detected hepatic (6/65 patients) and lung metastases (3/65 patients). CT colonography has better performance in the identification of colonic masses (diameter > 3 cm), in the completion of colonic evaluation and in the segmental localization of tumor. CTC should replace colonoscopy for preoperative staging of colorectal cancer.     

X线与CT检查对结肠癌的诊断价值

目的：探讨X线与CT扫描对结肠癌的诊断价值。材料与方法：对74例经活检、手术和病理证实的结肠癌患者的低张双对比钡剂灌肠造影和CT扫描图像进行分析。结果：通过低张双对比钡剂灌肠造影发现结肠癌患者66例,病变检出率为89．19％,其中黏膜改变：有61例患者,占92．42％;增生型：19例,占28．79％;浸润型：有56例,占84．85％;溃疡型：11例,占16．67％。CT扫描诊断的结肠癌患者为74例,病变检出率达100％。其中增生型：61例患者,占82．43％;浸润型：67例患者,占90．54％;溃疡型：19例,占25．68％。结论：低张双对比钡剂灌肠造影和CT扫描检查可有效地显示结肠癌的部位、大小、形态,能较为准确地判定结肠癌的侵犯范围及转移,对结肠癌的诊断意义重大。     

Screening of patients after colectomy: virtual colonography

Background Virtual colonography is a powerful new method of imaging the entire colon and is useful to assess polyps and diagnose colon cancer. We evaluated virtual colonography in the postoperative screening of patients who had colon cancer. Methods Fifty-three patients were examined with virtual colonography 12 to 48 months postoperatively. Forty-four patients had received segmental colectomy with restoration of the gastrointestinal tract, and nine patients underwent abdominoperineal resection and permanent colostomy. After proper cleaning of the colon and distention with air, spiral computed tomographic examination of the abdomen with a slice thickness of 5 mm (table speed [TS] 10 mm, reconstruction interval [RI] 2.5 mm) was performed in the supine and prone positions (including intravenous contrast medium infusion). Images were transferred to a separate workstation (Philips Easy Vision) for postprocessing, three-dimensional rendering, and endoluminal viewing. Results Eleven recurrences (16.41%) were identified in 10 patients by virtual colonography, but one recurrence was missed. Conventional colonoscopy was incomplete in six cases, and two patients with colostomy refused colonoscopy. In these eight cases (15%), virtual colonoscopy was completed without problems. A second tumor in one patient who had received abdominoperineal resection was demonstrated by virtual colonography, but conventional colonoscopy failed to demonstrate the lesion. Liver metastases were identified in only one patient. Conclusions Virtual colonography seems to provide a good alternative in the follow-up of patients after colectomy. The technique is effective in the diagnosis of locoregional recurrences and distant metastases and is well accepted by patients, and results are equal to those of the conventional colonoscopy.     

急诊多层螺旋CT检查在结肠癌合并肠穿孔中的应用

目的:评价多层螺旋CT(MSCT)对结肠癌合并肠壁穿孔的诊断价值。方法:回顾性分析21例经手术证实的结肠癌合并穿孔的临床及MSCT资料。结果:本组21例中,X线腹平片发现腹部游离气体15例,CT见腹部游离气体18例;21例均发现结肠管壁不同程度的增厚,伴有肠梗阻8例。CT术前正确诊断肠穿孔18例(85.7%);术前正确诊断肠癌合并穿孔16例(76.1%)。结论 :MSCT对结肠癌合并肠穿孔具有较高的术前诊断价值。     

鼻区骨折影像学检查的漏误诊分析

目的对比鼻区骨折X线摄片和CT检查中漏误诊发生率,以提高鼻区骨折诊断的正确性。方法收集同时经鼻骨侧位X线摄片和MSCT检查诊断为鼻区骨折的影像资料150例,回顾分析其X线和MSCT表现及漏误诊原因。结果鼻骨侧位X线片显示鼻骨骨折102例,其中线性骨折35例,线性骨折伴移位41例,粉碎性骨折26例,漏诊35例,误诊32例。CT诊断鼻骨骨折137例（其中线性骨折36例,线性骨折伴移位55例,粉碎性骨折46例）,复合性骨折88例,单纯鼻旁骨骨折13例;横轴面图像漏诊6例,误诊8例,冠状面图像漏诊8例,误诊9例,横轴面结合冠状面图像误诊1例。结论鼻部外伤患者仅作鼻骨侧位X线摄片容易漏诊,MSCT薄层扫描结合MPR、VR成像能全面观察鼻区细微结构和骨折改变。     

Ultrasonographic diagnosis of advanced colorectal cancer

We investigated the efficacy of transabdominal ultrasonography for the diagnosis of advanced colorectal cancer. Colonic examination by colonoscopy, barium study, or surgery was carried out in our institution on 1579 patients during the past 5 years. This study focused on 1564 of these patients, 15 who has been diagnosed with colorectal cancer before ultrasound examination having been excluded. The results included 51 ultrasound-positive cases, 9 ultrasound-false-positive cases, 1476 ultrasound-negative cases, and 28 ultrasound-false-negative cases. Sensitivity was 64.6 percent and specificity was 99.6 percent. Of the 28 ultrasound-false-negative cases, the lesion was detected in the ascending colon in 2, in the transverse colon in 6, in the descending colon in 1, in the sigmoid colon in 3, and in the rectum in 16. Obstruction and dilatation suggested colorectal cancer in 3 cases, which were thus classified as ultrasound-negative when no tumors were detected. Sensitivity was investigated by site. Sensitivity was lowest at 30.4 percent in rectal cancer, but was 78.6 percent in colon cancer, exclusive of rectal cancer. Laboratory findings and clinical symptoms which were suggestive of colorectal cancer were used as information before ultrasound examination was performed. Sensitivity of examinations carried out on examinees on whom prior information was available and on those on whom there was no information did not differ significantly. Furthermore, ultrasound was thought to detect approximately 65 percent of advanced colorectal cancers when it was used aggressively to investigate the large intestine. Ultrasound was thus considered effective for detecting advanced colorectal cancer.     

CT与磁共振成像对肝内胆管细胞癌的诊断价值

目的:探讨CT与磁共振成像(MRI)对肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)的诊断价值。方法:经手术或活检病理证实的ICC患者29例,其中15例行多层螺旋CT平扫和动态增强扫描,16例行MRI平扫和动态增强扫描。回顾分析肿瘤的形态学特征、CT及MRI影像学表现特征以及附属征象。结果:29例ICC,共检出32个病灶,肝左、右叶均见分布。CT共检出17个病灶,平扫仅1个病灶表现为混杂密度,其余均呈低密度;增强扫描动脉期显示10个病灶呈边缘强化,6个病灶呈轻度不均匀强化,1个病灶未见强化,门脉期显示12个病灶呈渐进性强化,5个病灶强化减退。MRI共检出17个病灶,T1WI、T2WI主要表现为混杂的异常信号;动态增强扫描动脉期显示16个病灶呈边缘环形或不规则强化,1个病灶无明显强化,门脉期和延迟期显示15个病灶瘤内实性部分的信号呈渐进性增强,强化程度更加明显,1个病灶瘤体边缘保持厚环状明显强化,1个病灶强化减弱。附属征象包括胆管扩张15例,局部肝包膜凹陷2例,肝叶萎缩1例,门静脉癌栓4例。结论:ICC的CT和MRI表现具有一定的特征性,动态增强扫描是其诊断和鉴别诊断的重要方法,术前详尽的影像学检查是及早发现ICC的重要途径。     

CT结肠造影二维和三维图像评价结肠病变的优势与不足

背景：随着多层探测器螺旋CT的广泛应用,已使胃肠道等空腔脏器的CT检查成为可能。目的：通过结肠充气CT结肠造影扫描,评价二维和三维图像对结肠病变检出的有效性以及各自的优势和不足。方法：38例患者导泻后经肛门注入适量空气,行多层螺旋CT扫描,再经工作站对扫描获得的容积数据进行后处理,获得多平面重组的冠、矢状面图像、表面重建、透明重建、仿真内窥镜和管腔展开图像,由2位有经验的影像科医师对上述图像进行分析,评价结肠病变的性质、位置、大小和肠外表现,并与电子结肠镜或手术病理结果对照。结果和结论：除1例为家族性息肉病外,其余37例患者共检出17枚息肉、20个结肠肿块和5例结肠炎性病变。对3种类型病变的检出率,多平面重组分别为82%、100%和100%;仿真内窥镜分别为100%、100%和80%;表面重建分别为41%,90%和40%;透明重建分别为47%、90%和40%。管腔展开技术对所检病变的显示率达100%。二维图像可对结肠病变准确定位并精确测量大小,在显示结肠病变肠外表现方面的优势明显,仿真内窥镜的敏感性较高,管腔展开技术又进一步避免了检查盲区,表面重建和透明重建在显示结肠全景方面价值较高。     

超声心动图联合增强CT对肺静脉异位引流的诊断价值

目的 探讨超声心动图（ECG）联合增强CT对肺静脉异位引流（APVC）的诊断价值。方法 回顾性分析经手术证实的34例APVC患者，术前均接受ECG检查，其中18例联合增强CT检查，统计诊断准确率、漏诊率、误诊率。结果 34例APVC患者中，ECG正确诊断28例（28/34，82.35%），漏诊3例（3/34，8.82%），误诊3例（3/34，8.82%）。经ECG联合CT诊断的18例患者中，单独经ECG正确诊断15例（15/18，83.33%），无漏诊，误诊3例（3/18，16.67%）；ECG联合CT正确诊断17例（17/18，94.44%），无漏诊0例，误诊1例（1/18，5.55%）。结论 ECG联合增强CT可准确诊断APVC。