多排螺旋 CT 诊断食管枣核异物的应用价值

目的：探讨多层螺旋 CT(MSCT)诊断食管枣核异物的应用价值。方法回顾我院16例食管枣核异物行食管钡餐造影检查、MSCT 扫描的患者资料,分析食管枣核异物食管钡餐造影检查及 MSCT 表现,并与内镜结果对照。结果16例食管枣核异物患者中,MSCT 检出异物16例(100%),食管周围并发症6例;食管钡餐造影检出异物6例(37.5%),并发症未检出。MSCT 对异物及并发症的检出率明显高于钡餐造影。结论 MSCT 及其重建技术如能准确显示食管异物及其周围并发症,可以作为食管枣核异物的首选检查方法。     

X线平片和CT诊断成人食管异物的ROC曲线分析

目的:比较X线平片和CT诊断食管异物的能力。方法:回顾性分析在内镜诊治前既行X线平片检查又行CT检查的成人食管异物患者43例,用多个诊断点(五等级法)分别判断两者检出食管异物的情况,以治疗后取出的食管异物36例(金标准)来分别验证两者漏诊和误诊的情况,再用ROC曲线下面积(AUC)比较两者诊断食管异物的准确性,并进一步比较两者发现食管异物穿孔的情况。结果 :X线诊断食管异物的AUC为0.609,CT的AUC为0.980,差异行Z检验,结果 Z=4.254,P<0.01,差异具有统计学意义。X线平片发现食管穿孔2例,而CT发现了6例。结论 :CT诊断成人食管异物优于X线平片,对于透X线的异物可作为内镜诊治前的首选。     

食管异物致食管穿孔三例

1 病例资料[例1] 男,34岁。因吞咽团后出现胸骨后疼痛并向背部放射1天入院。入院后患者主诉疼痛加剧,并出现发热和呼吸困难,立即行食管碘油造影,见第4胸椎平面食管穿孔,并有纵隔气肿。即开胸行食管修补术,术中仅见食管穿孔,未见异物,行食管修补术痊愈。     

异物性食管穿孔诊治的探讨

目的:探讨食管异物致穿孔的诊断和治疗方法。方法:本组选取食管异物致穿孔病例10例,对其临床特点、诊断方法及治疗措施进行分析。结果:5例颈段食管穿孔经颈入路手术治疗,其余胸段穿孔经食管修补配合胸腔引流均治愈出院。结论:早期诊断,采用颈入路手术、食管壁切开取出异物加食管壁修补胸腔闭式引流治疗方法,配以鼻饲或空肠造瘘,积极控制感染是降低颈段食管穿孔死亡率的关键。     

160例上消化道异物胃镜诊疗体会

目的:探讨上消化道异物的诊断与治疗方法.方法:上消化道异物患者160例(160件异物),均行颈、胸、腹部X线透视检查及胃镜检查,并在胃镜直视下钳取上消化道异物.结果:胃镜下取出异物158件,成功率98.75%.2例异物嵌入食管壁较深,局部黏膜炎症明显,疑穿孔可能,未取出异物,转外科手术治疗,证实为食管穿孔.成功取出异物者均未出现大出血,无死亡病例.结论:胃镜钳取异物安全、有效.     

MSCT及其后处理技术对食管异物的诊断及治疗的临床价值

目的探讨MSCT及其后处理技术在食管异物的诊断及治疗的临床价值。方法回顾性分析我院58例经过MSCT检查确诊并经食管镜或手术治疗证实的食管异物的CT影像资料。结果 MSCT异物检出率100%,并经食管镜或及手术方式全部取出,异物类型:鸡鸭骨头、鱼骨片、鱼刺、牙签、核仁、金属、肉团及塑料管棒等;并发症:5例合并穿孔,3例食管周围脓肿形成。结论 MSCT对食管异物检出率高,可发现细小异物,能准确显示异物形状特征、位置、有无并发症,可清晰多方位显示异物与食管周围组织的毗邻关系,可推荐作为食管异物的首选检查方式。     

64排螺旋CT及其后处理技术在老年人食管异物诊断中的价值

目的:探讨64排螺旋CT及其后处理技术在老年人食管异物诊断中的临床应用价值。方法:收集本院临床拟诊断食管异物的老年患者(≥60岁)39例,均采用64排螺旋CT行常规扫描及三维重建,其中1例加增强扫描,总结分析其CT表现,并将CT诊断结果与手术或胃镜检查结果作对照。结果:在39例患者中,CT诊断食管异物34例,CT表现为食管内高密度影,食管壁增厚,食管脓肿,食管穿孔,食管梗阻。64排螺旋CT及其后处理技术诊断老年人食管异物的敏感度为97.05%,特异度为80.00%,准确率为87.18%。结论:64排螺旋CT及其后处理技术对老年人食管异物有较高的诊断价值,可作为首选检查方法。     

食管穿孔6例分析

198 3- 11～ 2 0 0 0 - 0 4我科收治食管穿孔 6例 ,结果 ,4例治愈 ,2例死亡。现报告分析如下。1　临床资料本组男 5例 ,女 1例 ,年龄 2 3～ 5 9岁 ,平均 41岁。食管第一狭窄区穿孔 5例 ,第二狭窄区穿孔 1例。致病原因 :硬管食管镜及纤维胃镜检查伤 2例 ;由鸡骨、鱼刺、钢镊等异物尖锐刺伤 4例。本组均经 X线钡透、平片、吞碘造影及尸解证实。2　讨论2 .1　致病原因　 1手术器械直接损伤 ,本文 2例为手术检查所致 ,其发生与术前解释工作不充分 ,患者恐惧 ,配合不好 ;患者体胖颈短或头位太低 ,颈椎前凸 ,食管镜难于插入 ;麻醉不完全 ,未等环…     

覆膜食管支架在食管穿孔40例的应用分析*

目的探讨全覆膜食管支架治疗食管穿孔的效果和安全性。方法采用全覆膜金属支架治疗医源性、肿瘤及异物所致食管穿孔40例,观察对其的治疗效果及并发症。结果所有的食管穿孔患者一次性成功置入食管支架,术后均能顺利恢复进食;食管异物临时支架植入术后4天~1个月取出支架,复查胃镜及食管造影均明确穿孔愈合;3例食管癌并穿孔患者术后吞咽梗阻感明显缓解。主要并发症为术后胸痛及支架移位,6例(15%)出现支架移位,2例(5%)食管癌患者出现食物梗阻并支架移位。结论全覆膜金属支架治疗食管穿孔,具有疗效确切,并发症少,安全有效等优点。     

160例上消化道异物胃镜诊疗体会

目的:探讨上消化道异物的诊断与治疗方法。方法:上消化道异物患者160例(160件异物),均行颈、胸、腹部X线透视检查及胃镜检查,并在胃镜直视下钳取上消化道异物。结果:胃镜下取出异物158件,成功率98.75%。2例异物嵌入食管壁较深,局部黏膜炎症明显,疑穿孔可能,未取出异物,转外科手术治疗,证实为食管穿孔。成功取出异物者均未出现大出血,无死亡病例。结论:胃镜钳取异物安全、有效。     

Comparison of the toxicity of the radiocontrast agents, iopamidol and diatrizoate, to rabbit renal proximal tubule cells in vitro

Radiographic contrast agent-induced acute renal failure is an increasingly recognized clinical event. Multiple factors have been implicated in its development. Recent experiments have demonstrated that sodium diatrizoate, a common ionic radiocontrast agent, is moderately toxic to proximal tubule cells in vitro, and that this toxicity is enhanced by hypoxia. In this study, we compare toxicities of the nonionic radiocontrast agent, iopamidol, and the commonly used ionic contrast agent, diatrizoate. Suspensions enriched in proximal tubule segments were exposed for 82.5 min to 10 or 25 mM diatrizoate or 10 or 25 mM iopamidol with or without 22.5 min or 30 min of hypoxia. Cell viability parameters, including basal and uncoupled respiratory rates, tubule cell potassium and calcium levels and cell ATP content were measured. No consistent differences in tubule viability parameters were observed between tubule suspensions exposed to 10 mM concentrations of the radiocontrast agents during either oxygenated or hypoxic conditions. Under oxygenated conditions, both 25 mM iopamidol and diatrizoate exposure produced greater metabolic alterations in renal tubules than control conditions, but the effects were not statistically significant. With concomitant hypoxia, the alterations after 25 mM diatrizoate exposure were significantly greater than those seen after exposure to 25 mM iopamidol. Iopamidol had less of a detrimental effect on renal tubule potassium content and both basal and uncoupled respiratory rates than that of diatrizoate under these conditions. Thus, diatrizoate is more toxic to rabbit renal proximal tubule cells than iopamidol in vitro, and this difference in toxicity is enhanced by hypoxia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Esophageal prosthesis and its most common complications

Plastic prostheses of our own modification introduced under endoscopic control, have been successfully used in 46 patients with advanced malignant or scarred stenosis of the esophagus. Despite maximum care, their introduction is associated with a certain risk of complications and incidents. In our series, the introduction of a prosthesis was complicated by perforation of the canceromatous esophageal wall in 2 patients (0.5%), and by an esophagobronchial fistula observed 12 days post-operatively in 1 patient (0,25%). To preclude fatal mediastinal complications following perforation of the esophagus by the prosthesis, X-ray examination of its patency employing water-soluble contrast media in the early stages after surgery is recommended even before peroral nutrition is resumed.     

系统性硬皮病累及食管的X线表现与早期诊断

目的探讨系统性硬皮病（PSS）累及食管的X线表现与早期诊断。方法采用食道气钡双重造影,同时行立位及卧位多体位观察,并对其X线征象进行分析。结果PSS食道受累患者排空时间、管腔直径及黏膜均有不同程度异常。结论食道气钡双重造影是观察食管功能的有效检查手段,对早期诊断PSS具有极高价值。     

Successful nonoperative management of delayed spontaneous esophageal perforation in patients with human immunodeficiency virus

OBJECTIVE: To describe the clinical outcome of esophageal stenting for repair of distal esophageal perforation in one patient with septic shock and human immunodeficiency virus. DESIGN: Case report. SETTING: Medical-surgical intensive care units of one university teaching hospital. PATIENT: One patient with human immunodeficiency virus infection and septic shock in whom there was a delay in diagnosis of spontaneous perforation at the distal thoracic esophagus. INTERVENTION: A 10 cm x 2 cm silicone lined, partially coated, expandable metal stent was fluoroscopically placed in the distal esophagus at the perforation. Other treatment included chest tube thoracostomy, sump drainage of proximal esophagus, percutaneous gastrostomy, and antibiotics. MEASUREMENT AND MAIN RESULTS: Septic shock and the distal esophageal perforation were successfully treated with combined esophageal stenting, thoracostomy pleural drainage and antibiotics. Esophageal stenting was accomplished fluoroscopically with a partially coated, silicone-lined, expandable metal stent. CONCLUSION: Esophageal stenting, tube thoracostomy drainage, and antibiotics may be a management option for gravely ill patients with human immunodeficiency virus, esophageal perforation, and a delay in diagnosis. An optimal outcome requires a thoughtful, individualized approach and adherence to basic principles.     

Silicone-covered expandable metallic stents in the esophagus: an experimental study.

Modified silicone-covered Gianturco expandable metallic stents were placed in the normal esophagus of six young pigs. Following endoscopic examination, the stents were placed using endoscopic and fluoroscopic control. The animals were observed for eating behavior and weight gain. Stents appeared to be tolerated well based on these parameters. Three stents remained in position for the full study period, and three stents migrated into the stomach during the study. The pigs were sacrificed at four weeks and postmortem examination performed. Esophageal wall thickening and nodular inflammation were noted at the sites where the wire skirts penetrated the mucosa. Injury was limited to the region of the wire skirts and there was no injury due to the radial force of the stent body. There was no free perforation. This preliminary study suggests that endoscopic and fluoroscopic placement of modified silicone-covered Gianturco stents in the esophagus is feasible and safe. More extensive animal studies, followed by clinical investigation for palliation of malignant strictures, are warranted.     

自发性食管破裂临床分析--附18例报告

目的：探讨自发性食管破裂的早期诊断与治疗的必要性。方法：自1986年8月～2001年6月，18例自发性食管破裂病人接受外科治疗，开胸手术裂口修补5例；食管切除、食管胃胸膜顶吻合2例；裂口修补加胃造瘘3例；单纯胸腔闭式引流加空肠造瘘8例。结果：开胸手术10例，死亡1例，平均住院25d。保守治疗8例，死亡5例，死亡率(5／8)62．5％，平均住院45d。结论：自发性食管破裂早期诊断是治疗的关键，一旦诊断明确应积极开胸手术，即使发病超过24h，只要全身条件允许也应积极手术治疗。食管切除，食管胃吻合，较其它术式更为安全。     

实时超声造影在胆囊穿孔诊断中的应用价值

目的探讨实时超声造影在胆囊穿孔诊断中的应用价值。方法37例接受胆囊切除手术的患者行常规超声和实时超声造影检查。结果常规造声诊断胆囊穿孔23例,共穿孔24个;超声造影诊断胆囊穿孔28例,共穿孔32个;经手术病理诊断胆囊穿孔29例,共穿孔36个。以手术结果为金标准,常规超声诊断胆囊穿孔的敏感性为71．4％,特异性为66．7％,准确性为70．2％。超声造影诊断胆囊穿孔的敏感性为77．8％,特异性为100％、准确性为96．6％;对胆囊穿孔部位的敏感性为100％,诊断率为94．1％。超声造影的特异性、准确性高于常规超声（P〈0．01）。结论胆囊穿孔实时超声造影表现具有特征性,且对胆囊穿孑L部位诊断准确性很高,可作为诊断胆囊穿孔的重要检测手段。     

食管入口病变的X线钡剂和CT检查及其临床意义

目的：分析食管入口病变的临床以及X线和CT表现,探讨食管入口病变的影像学检查方法,以提高食管入口病变的影像学诊断水平。方法：回顾分析34例经临床、手术、穿刺和病理证实的食管入口病变患者的临床和影像学资料。34例均行CT检查,其中27例行增强前后CT扫描,7例仅行CT平扫。34例中有28例行X线钡剂检查。结果：34例食管入口病变包括原发于食管入口的肿瘤14例（鳞癌12例、未分化癌2例）、食管入口括约肌肥厚3例、食管入口憩室5例、食管入口损伤12例。34例食管入口病变均有吞咽障碍的临床症状,食管入口癌的中晚期,吞钡检查可见食管入口黏膜破坏。肿瘤早期CT表现不明显,中晚期病人食管入口壁可有不规则增厚或肿块。环咽肌肥厚者,CT表现为食管壁局部增厚,黏膜光滑。食管入口憩室者,CT表现为食管入口侧壁不强化的软组织肿块,吞钡可见食管一侧囊袋状龛影,有钡剂进入。食管入口破裂者吞钡时,可见钡剂溢入颈部软组织,2例食管入口破裂、穿孔并发纵膈脓肿者CT可见上纵膈增宽,增强扫描后见低密度脓腔。结论：X线钡剂检查对食管入口病变的诊断,目前仍有不可替代的作用,它简便易行、费用低廉、易被患者接受。CT对食管入口肿瘤的定性、分期,对食管入口损伤及其并发症的观察有重要意义,若将两者结合起来,能提高食管入口病变的影像学诊断水平。     

Clinical signs and radiographic evidence of esophageal perforation after tetraplegia

A diagnosis of esophageal perforation at some time after cervical spine surgery is difficult to establish since there exists no clinical picture specific to tetraplegic patients. We carried out a detailed retrospective study of revelatory clinical manifestations and conventional radiographic data in a series of 16 patients hospitalized at Hôpital Henry-Gabrielle (Lyon, France) for rehabilitation purposes between 1983 and 2010 and who presented this complication. The most frequent clinical picture associates cervical pain, fever and dysphagia. Simple front and side X-rays of the cervical spine led in 77% of the cases to a diagnosis of esophageal perforation. The most prevalent radiographic signs of the latter consist in osteosynthesis hardware or instrumentation failure, prevertebral free air next to the cervical esophagus and enlarged prevertebral space. Visualized esophageal X-rays, also known as series, highlight parenchymal opacity next to the posterior wall of the esophagus. A diagnosis of esophageal perforation needs to be carried out in order to facilitate suitable treatment and avoid the compromising of vital functions.     

胶囊内镜对食管疾病的诊断价值

目的：探讨胶囊内镜对食管黏膜的观察能力及对食管疾病的诊断价值。方法：80例行胶囊内镜检查的患者前瞻随机分组为研究组和对照组,每组40例。观察不同体位下胶囊内镜对食管黏膜的观察情况,并与胃镜检查结果进行比较。结果：实验组可获得平均长为599s和1209帧食管图像以供诊断使用,显著高于对照组的9s和18帧（P〈0.01）。胶囊内镜观察结果与胃镜检查结论具有一致性。结论：胶囊内镜对食管黏膜的观察和疾病的诊断是安全可行。