原发性小肠肿瘤的临床诊治体会

小肠肿瘤误诊率高，尤其在基层医院表现得更为突出，自1993年以来至今共收治的15例不同病理类型小肠肿瘤的诊治经过报告如下：     

MSCT在小肠肿瘤诊断中的临床价值

目的 探讨多层螺旋CT在小肠肿瘤性疾病诊断中的临床应用价值.方法 回顾性分析经手术及病理证实的32例小肠肿瘤的多层螺旋CT表现.结果 本组发生于十二指肠12例,空肠7例,回肠13例.13例腺癌、10例间质瘤、6例非霍奇金淋巴瘤及3例转移癌.结论 多层螺旋CT在小肠肿瘤诊断中的价值较大,尤其是增强扫描,大大提高了病灶的检出率,对常见小肠肿瘤的诊断与鉴别诊断具有较高的临床应用价值.     

MSCT对小肠肿瘤的诊断价值

目的：探讨MSCF对小肠肿瘤的诊断价值。方法：前瞻性对24例临床疑有小肠肿瘤的患者行MSCT检查，检查前晚口暇甘露醇250ml清洁肠道，检查前30分钟肌注654—220mg，抑制肠道蠕动。分别于检查前120、90、60、30和15分钟各服200ml温开水充盈肠道。常规做平扫和增强扫描（动脉期、门脉期、扫描）。并行冠、矢状位重建和曲面重建，来多角度的显示小肠肿瘤的位置、形态以及肿瘤与周围结构的关系。结果：24例中共检出小肠肿瘤21例，其中脂肪瘤2例、腺癌4例、间质瘤6例、淋巴瘤9例。经手术及病理证实，MSCT定位定性完全准确。另3例MSCT未见明显异常，并经消化道造影证实。且随访半年以上，未见异常。结论：MSCT及其后处理技术对小肠肿瘤的检出率高，是小肠肿瘤可靠的检查技术。     

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.     

原发性小肠肿瘤临床误诊8例分析

原发性小肠肿瘤临床误诊８例分析于健伟，殷允生，沈宁，周潮勇，韩晓东原发性小肠肿瘤少见，临床表现无特异性易误诊，我院１９８５年～１９９１年经手术，病理证实巴例，现报告如下。１临床资料男４例，女４例。年龄３７岁～６６岁，７例４０岁以上。良性２例，恶性６例...     

原发性小肠肿瘤的CT诊断

本文介绍了小肠肿瘤CT的检查方法,各种小肠肿瘤的CT表现及其鉴别诊断。小肠肿瘤CT诊断的基本条件是良好的肠道准备。目前认为在肠道内造影剂衬托下,CT上小肠肿瘤一般表现为肿块和/或肠壁节段性明显增厚。CT常能鉴别肿瘤与非肿瘤、肿瘤的良恶性,对部分小肠肿瘤CT甚至能作出正确的组织学分类诊断,CT尚可观察小肠恶性肿瘤的局部侵犯及远处转移。     

X线检查在小肠肿瘤诊断中的价值

小肠肿瘤在消化道肿瘤中较为少见,而且检查方法有限,目前除X线检查外,尚无其它更为有效、更清晰地显示病变及其部位、大小和范围的方法。本文收集了我院10余年来经手术及病理证实的小肠肿瘤47例,进行临床及X线分析,并对检查方法及漏诊原因等作进一步的探讨。现报告如下。1材料与方法47例患者中男性19例,女性28例,女性多于男性,平均年龄48岁,病程:1月~10年。临床症状:腹胀、腹痛24例,其中阵发性腹痛6例,2例向背部放射,绞痛3例,单有腹胀3例;呕吐5例;消化道出血19例,约占40%,其中血便6例,黑便7例,大便隐血阳性6例;腹部包块15例,约占31%;贫血头…     

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。     

腹腔镜辅助阴道式子宫切除术的临床应用价值

目的探讨腹腔镜辅助阴式子宫切除术(LAVH)的适应证及临床应用价值。方法对103例因各种良性妇科疾病而需行子宫全切除术的患者,采用阴式子宫切除术(TVH)和LAVH术式。结果两组手术在手术时间、术中出血、术后下床活动时间、术后住院天数等方面差异无统计学意义,在术后肛门排气时间方面有差异(P<0.05)。结论 LAVH拓宽了阴式子宫切除的适应证,可避免开腹、减少手术创伤。     

小肠肿瘤54例诊断分析

我们收集两院1965～1993年经病理确诊的小肠肿瘤54例，讨论其临床表现及早期诊断。1临床资料1．1一般情况本组男34例，女20例，男：女为1．7：1。年龄10～74岁，平均33．8岁。良性17例（年龄10～64岁，平均33．5岁），恶性37例（年龄3～74岁，平均39．2岁），良：恶为1：2．1。1．2病变部位与组织学类型位于十二：指肠22例（占41％），其中腺癌11例，腺瘤6例，类癌与P－J综合征各2例，异位胰腺1例；空肠7例（占13％），其中腺癌、平滑肌瘤及平滑肌肉瘤各2例，恶性神经鞘瘤1例；回肠20例（占37％），其中恶性淋巴瘤7例，腺癌与类癌各4例，平…     

小肠原发性肿瘤的影像学诊断

目的探讨小肠原发性肿瘤的CT和消化道造影诊断。方法40例经手术、病理证实的原发性小肠肿瘤33例恶性和7例良性全做消化道钡餐造影，其中28例又经CT扫描检查。结果消化道造影见肠腔狭窄20例（13例恶性，7例良性），充盈缺损19例，（13例恶性，6例良性），肠梗阻13例，（10例恶性3例良性），管壁僵硬、黏膜破坏及环状皱襞消失主要见于恶性肿瘤f22例恶性）。CT扫描发现腹内肿物28例。结论消化道钡餐造影对小肠原发性肿瘤有良好的显示，还可以发现CT所不能显示的黏膜面，仍是小肠原发性肿瘤简便的首选检查方法，CT为重要的补充检查。     

口服等渗甘露醇螺旋CT肠造影对小肠肿瘤的诊断应用

目的评价口服大剂量2.5%等渗甘露醇螺旋CT小肠造影(SCTE)在小肠肿瘤诊断中的价值。方法 36例经手术病理证实小肠肿瘤患者每人口服2.5%等渗甘露醇约1000～1500 mL后,肌注20 mg山莨菪碱注射液,10～15 min后行螺旋CT三维扫描,分析不同小肠肿瘤的表现,并比较42例常规CT扫描与SCTE的诊断结果。结果 36例患者除2例回盲部充盈欠佳外,其余34例十二指肠,空肠及回肠肠腔充盈良好,对肿瘤的显示、衬托满意。SCTE检查与临床诊断符合率为94.4%(34/36),高于常规扫描78.57%(33/42)。结论 SCTE是一种简便、安全、非侵袭性,有效评价小肠肿瘤的方法,能明显提高肿瘤的检出率。     

小肠磁共振成像的研究进展

影像学检查是诊断小肠疾病的主要检查方法,近年来随着磁共振技术的迅猛发展,磁共振小肠成像临床应用越来越广泛,本文拟从比较影像学、标本及动物实验研究、临床研究等几个方面对小肠的磁共振成像研究状况进行综述,以期对小肠的磁共振检查技术有一个整体的认识。     

CT findings of small bowel trichobezoar

A 14-year-old girl presented to our emergency room with abdominal pain and persistent vomiting. A plain radiograph of the abdomen showed features of small bowel obstruction, with dilated loops of small bowel and a mottled gas and debris pattern in the stomach and right lower quadrant. A CT scan of the abdomen and pelvis obtained to exclude appendicitis showed the distinctive appearance of a trichobezoar. A preoperative diagnosis of gastric and intestinal trichobezoar was made. Electronic Publication     

Carcinoid tumors of the small-bowel: Evaluation with 64-section CT-enteroclysis

Purpose

To describe the imaging presentation of carcinoid tumors of the small-bowel at 64-section CT-enteroclysis and determine the sensitivity of this technique for tumor detection.

Patients and methods

The 64-section CT-enteroclysis examinations of 22 patients with histopathologically proven small-bowel carcinoid tumors and those of 6 patients with suspected recurrence after small-bowel resection for carcinoid tumor were reviewed. Images were analyzed with respect to imaging presentation. Sensitivity, specificity, and accuracy, of 64-section CT-enteroclysis for the diagnosis of carcinoid tumor of the small-bowel were estimated with 95% confidence intervals (CIs).

Results

Twenty-five carcinoid tumors were confirmed in 22 patients (prevalence, 22/28; 79%). Overall sensitivity for carcinoid tumor detection was 76% (19/25; 95%CI: 55–91%) on a per-lesion basis. On a per-patient basis, 64-section CT-enteroclysis had a sensitivity of 86% (19/22; 95%CI: 65–97%), a specificity of 100% (6/6; 95%CI: 54–100%) and an accuracy of 89% (25/28; 95%CI: 72–98%) for the diagnosis of carcinoid tumor. Focal small-bowel wall thickening, mesenteric stranding, and mesenteric mass were found in 20/22 (91%), 18/22 (82%) and 15/22 (68%) patients with pathologically confirmed tumors.

Conclusion

64-Section CT-enteroclysis shows highly suggestive features for the diagnosis of carcinoid tumor of the small-bowel and achieves high degrees of sensitivity for tumor detection.     

CT findings of phytobezoar associated with small bowel obstruction

The purpose of this study was to evaluate CT findings of phytobezoar associated with small bowel obstruction. We evaluated abdominal CT of 19 patients with phytobezoar. Abdominal CT of 6 patients with small bowel feces was included for the comparison. On CT we analyzed morphological features of phytobezoars such as location, number, size, shape, and the presence or absence of an encapsulating wall. The sites of the phytobezoar were in the jejunum in 12 patients (63%) and the ileum in 7 (37%). The phytobezoars were single in number in 13 patients (68%) and multiple in 6 (32%). The mean short- and long-axis diameters of the phytobezoars measured 3.2 cm (range 2.1–5.2 cm) and 5.2 cm (range 2.2–11.0 cm), respectively. The phytobezoars were ovoid in 9 patients, round in 6, and tubular in 4. On CT, phytobezoars appeared as gas-containing masses in 17 patients (89%) and as a solid mass without gas in the remaining 2 patients (11%). An encapsulating wall was noted in 6 patients (32%). Small bowel feces were much more tubular in shape but did not have encapsulating wall on CT. The CT imaging is useful in making the diagnosis of phytobezoar associated with small bowel obstruction. Electronic Publication     

口服甘露醇CT小肠造影诊断常见小肠肿瘤的临床应用研究

目的总结口服甘露醇CT小肠造影(MSCTE)对常见小肠肿瘤的诊断价值及其临床意义。方法选取口服等渗甘露醇溶液、肌注654-2后行CT小肠造影检查的受检者中经手术及小肠镜病理证实的71例小肠肿瘤患者作为研究对象,分析常见小肠肿瘤的影像学特征。结果 71例小肠肿瘤中,间质瘤(34例)、淋巴瘤(15例)、腺癌(10例)位于前三位,定位及定性准确率分别为98.6%和90.1%。结论口服甘露醇CT小肠造影对小肠原发性肿瘤的诊断具有重要价值,有助于小肠原发肿瘤诊断及鉴别诊断,具有重要临床价值。     

Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention

To assess the effect of the osmolarity for small bowel distension in MRI, ten volunteers ingested at two separate occasions negative oral contrast agents with different quantity and osmolarity: (1) a water solution combined with 2.0% sorbitol and 0.2% locus bean gum (LBG) with a quantity of 1500 ml and an osmolarity of 148 mOsmol/l, (2) a water solution combined with 2.0% sorbitol and 2.0% barium sulphate with a quantity of 1000 ml and an osmolarity of 194 mOsmol/l. Small bowel distension was quantified on coronal 2D-TrueFISP images by measuring the small bowel diameters. There were no statistically significant differences in mean small bowel diameter between both contrast agents. The mean small bowel distension was 19.2 mm after ingestion of 1500 ml of sorbitol-LBG solution and 19.0 mm after ingestion of 1000-ml sorbitol–barium sulphate solution. Furthermore, all volunteers found the ingestion of 1000-ml solution more pleasant than the 1500-ml solution. The ingestion of 1000 ml of sorbitol–barium sulphate solution led to a sufficient small bowel distension compared to 1500 ml of sorbitol–LBG solution. The side effect rate of both solutions was low. Based on these data, we recommend a quantity of 1000 ml of sorbitol–barium sulphate solution as an alternative for 1500-ml sorbitol–LBG solution for optimal bowel distension.     

US and CT findings of small bowel neoplasms

Small bowel (SB) neoplasms are very rare tumours, but are still associated with high mortality rates, since the tumour-related symptoms occur late and are non-specific. In addition, endoscopy is not feasible in most cases, and radiological contrast studies do not reach the high accuracy obtained in the evaluation of upper and lower gastrointestinal tract. Cross-sectional imaging, and particularly CT, is becoming increasingly relevant in the diagnosis of these tumours. Both US and CT allow tumour detection, even when performed on an emergency basis, and are capable of showing the lesion as well as possible complications. Moreover, CT offers the possibility of a preoperative staging by evaluating tumour extension through the bowel wall, lymph node involvement and possible metastases. Finally, in most cases a direct correlation between cross-sectional findings and histology can be found, thus permitting tumour characterisation. Received 27 June 1996; Revision received 11 October 1996; Accepted 4 February 1997     

Normal small bowel wall characteristics on MR enterography

Purpose

To assess the normal small bowel parameters, namely bowel diameter, bowel wall thickness, number of folds (valvulae connivientes) per 2.5 cm (in.), fold thickness and interfold distance per small bowel segment (duodenum, jejunum, proximal ileum, distal ileum and terminal ileum) on MR enterography.

Materials and methods

Between September 2003 and January 2008, 280 MR enterography examinations were performed for investigation of known or suspected small bowel pathology. 120 of these examinations were normal. Sixty-five (m = 29, f = 36, mean age = 34 years, range = 17-73 years) of 120 examinations without a prior small bowel diagnosis, with no prior or subsequent abnormal radiology or endoscopy examinations, no prior small bowel surgery and with a minimum 3 years follow-up demonstrating normality were retrospectively evaluated for the described small bowel parameters.

Results

We found the mean diameter of the duodenum to be 24.8 mm (S.D. = 4.5 mm), jejunum to be 24.5 mm (S.D. = 4.2 mm), proximal ileum to be 19.5 mm (S.D. = 3.6 mm), distal ileum to be 18.9 mm (S.D. = 4.2 mm) and terminal ileum to be 18.7 mm (S.D. = 3.6 mm). The number of folds per 2.5 cm varied from 4.6 in the jejunum to 1.5 in the terminal ileum. The fold thickness varied from 2.1 mm in the duodenum to 1.8 mm in the terminal ileum. The small bowel parameters gradually decreased in size from the duodenum to the smallest measurements which were in the terminal ileum. The bowel wall is similar in size throughout the small bowel measuring 1.5 ± 0.5 mm.

Conclusion

These results provide the mean, range of normality and standard deviation of the small bowel parameters per segment on the current population on MR enterography. From our experience, knowledge of these parameters is extremely helpful and essential in the everyday assessment of MR enterography studies.