老年粪石性肠梗阻1例

患者,男,68岁。2009-06出现便秘,服用＂麻仁润肠丸、复方芦荟胶囊＂,同时在我部卫生所予以灌肠,解出2次黄色成形软便,量少,4 d后自觉腹胀加重并停止排气,有间断腹痛,无发热,无恶心、呕吐,腹部平片示：横结肠扩张,可见气液面。于2009-06-25以＂不完全性肠梗阻＂住北京军区总医院。经灌肠通便及灌注石蜡油,排干燥大便,腹胀稍缓解。     

粪石性肠梗阻42例内科治疗分析

目的探讨粪石性肠梗阻的病因、诊断及内科处理经验。方法回顾分析近3年我科收治的42例粪石性肠梗阻的临床资料。结果 40例通过内科治疗,即给予胃肠减压、内镜下碎石、结肠治疗机洗肠等治疗后治愈,2例内科治疗无效后行手术治疗。结论结合典型病史及B超检查、腹部平片、内镜检查,可提高粪石性肠梗阻诊治的准确率,内科治疗解除粪石性肠梗阻是可行有效的办法。     

急性细菌性痢疾伴粪石性肠梗阻1例

病人 ,女 ,2 5岁。无明显诱因出现腹泻 ,为黄色稀便 ,5次 /ｄ ,伴腹胀 3ｄ ,恶心、呕吐 ,为胃内容物 ,非喷射性呕吐 1ｄ ,查体 :体温 36 5℃ ,脉搏 84次 /ｍｉｎ ,血压 1 1 0 /70ｍｍＨｇ ,意识清楚 ,心肺无特殊 ,腹部平坦 ,未见肠型及蠕动波 ,全腹柔软 ,无压痛及反跳痛 ,肝脾     

手术治疗粪石性肠梗阻12例临床分析

目的：分析粪石肠梗阻近年比例变化、病变成因及手术指征。方法：对本院2006-06-2010-09所收治的12例粪石性梗阻患者的临床资料及诊治过程进行回顾性分析。结果：本组病例全部治愈,1例因切口感染。结论：对于粪石肠梗阻争取做到早诊断,早期手术治疗,避免成肠道本身的病理改变,而且引起人体严重的生理紊乱。     

老年粪石性肠梗阻非手术治疗临床分析

目的探讨老年性粪石性结肠梗阻高位灌肠等非手术治疗的安全性和疗效。方法回顾性分析29例老年性粪石性结肠梗阻患者的临床资料。结果患者以结肠治疗机高位灌肠及奥曲肽静脉维持为主,非手术治疗治愈27例;转外科手术2例。无一例发生肠道穿孔、死亡。结论以结肠治疗机高位灌肠及奥曲肽静脉维持治疗老年性粪石性结肠梗阻,安全性高、疗效满意。老年性粪石性结肠梗阻往往病情危重,易误诊,故早期诊断、及时处理、把握手术时机是提高本病治疗疗效的关键。     

高密度粪石引起不完全性肠梗阻6例的CT诊断

目的：探讨全腹部CT平扫在诊断高密度粪石引起不完全性肠梗阻的临床应用价值。方法：6例病例均行全腹部CT平扫检查，保守治疗2～4d后行全腹部CT平扫复查。结果：高密度粪石引起的不完全性肠梗阻症状多样，Cr特征性表现为高密度蜂窝样粪石充满大段结肠内，结肠扩张积气，口服肠道润滑剂和灌肠治疗有效。结论：全腹部CT平扫是诊断本病的主要方法，病史、病因和CT特征性表现是诊断本病的主要依据。     

小肠粪石的CT表现

小肠粪石很少见,以往影像学报道多见于消化道X线造影检查和超声检查。笔者观察小肠粪石在CT上有典型表现,报道如下,以提高认识。1材料与方法搜集经手术病理证实的小肠粪石3例,其中男2例,女1例。年龄分别为30岁、65岁、69岁。1例因胃癌曾行胃大部切除手术,其余2例无胃肠道手术史。患者均以肠梗阻就诊,均行小肠切开取石术证实为小肠粪石。使用SiemensPlus4型螺旋CT机行全腹部平扫,上至膈顶,下至耻骨联合。层厚10mm,间距10mm.2例患者检查前2h分次口服2%～3%浓度的泛影葡胺水溶液1000ml。1例患者未口服造影剂,直接行SCT检查。2结果3例均表现…     

MSCT对评估粪石性小肠梗阻保守治疗可通过性的价值研究

目的 探讨多层螺旋CT(MSCT)及其重组技术对粪石性小肠梗阻保守治疗可通过性的评估价值.方法 搜集本院经手术及临床证实的50例粪石性小肠梗阻患者,根据保守治疗后粪石是否通过,分为通过组和非通过组,所有患者均在治疗前1天内行全腹MSCT扫描,并根据MSCT图像追溯粪石梗阻的部位,测量粪石短径、粪石长径、粪石平均CT值、...     

螺旋CT及重组技术对粪石性肠梗阻的诊断价值

目的:评价螺旋CT及重组技术对粪石性肠梗阻的定位、定性的诊断价值.方法:对35例经手术证实为粪石性肠梗阻的螺旋CT表现及重组技术进行回顾性分析.结果:螺旋CT对粪石性肠梗阻的定位诊断35例(100%)均正确:空肠5例,空回肠交界处17例,回肠13例;32例(91.4%)定性诊断正确,1例粪石误诊为肠套叠,2例误诊为肿瘤.主要征象有:肠梗阻(35/35,100%),类圆柱形或椭圆柱形相对低密度灶(31/35,88.6%),病灶内呈筛状结构和"气泡征"(27/35,77.1%)及肠壁强化征(27/35,77.1%).结论:粪石性肠梗阻有典型的CT表现,螺旋CT及MPR、STS-MIP重组对粪石性肠梗阻的定性、定位诊断具有重要的临床价值.     

植物粪石性急性小肠梗阻的CT诊断

目的:探讨植物粪石性急性小肠梗阻(SBO)的CT表现和诊断价值。方法:回顾性分析经外科手术证实的12例植物粪石性急性SBO患者的临床资料和CT表现。结果:12例小肠植物粪石均为单发,其中3例同时伴有胃内粪石。小肠粪石大小3 cm×3.5 cm～4.2 cm×5 cm,在CT上均表现为一个边缘清楚的卵圆形或圆形含有气泡的斑点状软组织肿块,位于梗阻部位的管腔内,其中位于十二指肠1例,空肠4例,回肠7例。所有病例均显示粪石近段小肠扩张(管径>3 cm),远侧小肠突然萎陷。结论:小肠植物粪石具有特征性的CT表现,CT检查是诊断植物粪石性急性SBO的最佳方法。     

多层螺旋CT血管成像技术在腹部扫描中的应用

目的 探讨多层螺旋CT扫描方法及三维重建技术在腹部血管成像中的应用。方法 6例肝占位病变患者，15例肝移植患者进行CT扫描检查，三维重建技术应用最大密度投影法(M1P)和表面遮蔽法(SSD)。结果 所有患者均一次顺利完成检查，19例清晰显示血管分支与走行。结论 MSCTA是目前一种分辨率高、快速、准确，无创性血管成像方法。     

多层螺旋CT三维重建在脊柱骨折中的应用研究

目的探讨多层螺旋CT（MSCT）三维重建诊断脊柱骨折的应用价值。方法对200例脊柱创伤患者进行螺旋CT容积扫描,将原始图像进行软组织算法及骨算法薄层重建,然后将薄层重建图像导入Syngo3D软件工作站,进行MPR,MIP,SSD和VR成像。结果多层螺旋CT三维重建清晰直观显示了脊柱骨折的部位、类型、脱位、稳定性情况及三维空间关系;对内固定术后脊柱,能清楚显示内固定物与周围组织的关系及固定物立体形态。结论MSCT三维重建成像可全面、清楚、直观、立体、多方位地观察骨折伞貌及术后改变,为临床选择治疗方案、制定手术路径及随访提供可靠依据。     

肺错构瘤的多层螺旋CT诊断

目的分析肺错构瘤的CT表现,并提高其诊断准确性。方法 31例由病理证实的肺错构瘤患者均经16层螺旋CT胸部平扫与增强扫描。对所有患者肿瘤病灶的部位、形态、大小、数目及强化特征,进行了回顾性总结分析。结果 CT扫描证实,25例(81%)的错构瘤是肺内型,其中包括24例孤立型和1例多发型,4例合并周围型肺癌。另外6例(19%)的错构瘤是支气管腔内型。绝大多数(30/31)患者的肿瘤CT表现是以边缘光滑锐利的圆形或卵圆形、直径小于3 cm的肿块影为特征。此外,还可看到其他或多或少的伴发征象,诸如,规则的圆形或卵圆形结节(58%),不规则形结节(48%),软组织密度结节影(55%),钙化影(35%),以及脂肪密度影(13%)。在对比增强CT像上,所有错构瘤病灶均表现为轻度强化(强化值小于30 HU)。结论除钙化及脂肪密度外,边界清晰及增强后轻度强化是诊断肺内型错构瘤的重要依据。而支气管腔内结节出现钙化或脂肪密度则高度提示支气管腔内型错构瘤。     

多层螺旋CT对鼻骨骨折的诊断价值

目的探讨多层螺旋CT对鼻骨骨折的诊断价值。方法应用GElightspeed多层螺旋CT机,对50例鼻骨骨折患者的鼻骨冠状位扫描、3D和MPR重建图像进行分析。结果50例均有鼻骨骨折,骨折同时累及上颌骨额突46例,累及鼻泪管1例;鼻中隔骨折15例,鼻额缝分离10例;鼻骨间缝分离5例;并发眶壁骨折3例;上颌窦壁骨折2例。结论多层螺旋CT的冠状位扫描、3D和MPR对于诊断鼻骨骨折具有重要价值。     

Multiplanar functional imaging of the larynx and hypopharynx with multislice spiral CT

The purpose of this study is to evaluate multislice spiral CT (MSCT) in multiplanar functional imaging of the larynx and hypopharynx and to define the optimal image planes for the delineation of the tumor and specific anatomical structures. Forty patients with suspected tumors of the larynx or hypopharynx were examined with MSCT during quiet breathing (QB), E-phonation (EP) and modified Valsalva maneuver (VM). Images were read in the axial, coronal and sagittal planes. Overall image quality, delineation of the tumor and anatomic structures for different conditions and orientations were graded using a three-point scale; the conditional permutation test was applied to detect quality differences. Differences between image types were statistically significant. The axial plane was superior in overall image quality and the delineation of the tumor, pyriform sinus, vocal cords and fat within the parapharyngeal/visceral space. The coronal plane was best for delineating the ventricle and the paraglottic space, the sagittal plane for the retropharyngeal and the preepiglottic space. For tumor detection, sensitivity, specificity and accuracy were 0.92, 1.0 and 0.93 for QB.ax, 0.94, 0.8 and 0.92 for EP.ax and 0.85, 1.0 and 0.87 for VM.ax, respectively. Examination during QB should be the standard procedure; additional scanning with EP improved tumor assessment.     

Diagnosis of bronchiectasis with multislice spiral CT: accuracy of 3-mm-thick structured sections

The aim of this study was to evaluate the accuracy of 3-mm-thick reconstructed sections in the diagnosis of bronchiectasis with multislice CT (MSCT). Forty consecutive patients suspected of bronchiectasis (23 females, 17 males; mean age 51 years) underwent MSCT of the entire thorax with a 4×1-mm collimation (120 kV, 0.5 s/rotation, 80 mAs/slice) and a pitch of 1.75. From each data set (mean z-axis coverage: 257 mm; mean duration: 21 s), two series of images were systematically generated: 1-mm (group 1) and 3-mm (group 2)-thick reconstructed scans. Both series of images were obtained at 10-mm intervals and reconstructed with a high-spatial-frequency algorithm. Two observers independently analyzed the presence of bronchiectasis and associated abnormalities in group-1 and group-2 lung images. No significant difference between group 1 and group 2 was found in: (a) the detection of bronchiectasis, identified in 24 patients (60%) in group 1 and in 23 patients (57.5%) in group 2 (p=0.08); (b) the evaluation of the extent of bronchiectasis, identifying focal bronchiectasis in 10 patients (25%) in group 1 and 7 patients (17.5%) in group 2 (p=0.39) and multifocal bronchiectasis in 16 patients (40%) in both groups; (c) the characterisation of bronchiectasis (cylindral bronchiectasis: group 1, n=24, 60%; group 2, n=21, 53%, p=0.08); varicose bronchiectasis: group 1, n=5, 12.5%; group 2, n=6, 15%, p=0.56); and cystic bronchiectasis: group 1, n=2, 5%; group 2, n=2, 5%). Apart from the identification of abnormal bronchial wall thickening (group 2, n=35, 87.5%, vs group 1, n=31, 77.5%, p<0.05), recognition of associated bronchopulmonary anomalies did not differ between the two groups. This study demonstrates a comparable accuracy of the 3- and 1-mm-thick reconstructed scans in the detection and characterization of bronchiectasis. These results suggest the potential usefulness of 3-mm-thick scans generated from 4×2.5-mm acquisitions in the screening of bronchiectasis, which would allow a 20% radiation dose reduction compared with the present investigation. Electronic Publication     

Coronary artery aneurysm and type-A aortic dissection demonstrated by retrospectively ECG-gated multislice spiral CT

The case of a 40-year-old male patient with a coronary aneurysm of the proximal left descending artery (LAD) combined with circumferential type-A dissection of the ascending aorta is reported. Computed tomography angiography of the coronary arteries was performed using multislice spiral computed tomography (MSCT) with retrospective ECG gating. Anatomical relations of the LAD aneurysm as well as the origin of the left coronary artery from the false lumen of the dissection were well depicted for planning of the surgical intervention using this new noninvasive imaging modality.     

Pancreatic carcinoma: the role of high-resolution multislice spiral CT in the diagnosis and assessment of resectability

The purpose of our study was to evaluate multislice computed tomography (MSCT) in the assessment of patients with clinical, laboratory, and US suspicion of pancreatic neoplasm, and to evaluate resectability status. Forty-six patients with a suspected pancreatic tumor underwent MSCT. After a preliminary precontrast survey, a postcontrast scan was performed in the arterial and portal venous phase with the following protocol: 4×1-mm collimation; 1.25- and 5-mm slice thickness width, respectively, and 1- and 5-mm reconstruction interval. In all patients pathological correlation was obtained. The evaluation of all images provided a diagnosis in 44 patients, with a sensitivity, specificity, and accuracy of 97, 80, and 96%, respectively. The MSCT correctly provided a diagnosis of unresectability with sensitivity of 96%, specificity of 86%, and accuracy of 93%. Evaluation of 1-mm slices demonstrated 83 of the 91 liver metastases found at surgery; conversely, the 5-mm slices detected only 76 of these lesions. Infiltration of peripancreatic major vessels was demonstrated, and was confirmed at surgery in 18 patients. High-resolution MSCT improves prediction of resectability in patients with suspected pancreatic carcinoma. Parenchymal and vascular information can be achieved with a single MSCT examination. Electronic Publication     

多层螺旋CT及曲面重建在颌骨疾病中的应用

目的：通过对24例颌骨疾病的曲面重建图像分析，探讨多层螺旋CT(MSCT)及曲面重建在颌骨疾病中的应用价值。方法：使用MSCT对颌骨进行1.25mm／4i薄层扫描，扫描范围自颞颌关节至下颌骨，将原始轴位图像用曲面重建软件(panorex display)重建成平行于颌弓的曲面断层图像和垂直于颌弓的矢状断面图像。结果：12例颌骨骨折都完整地显示出骨折的部位、类型及与上颌窦、牙槽骨的关系以及颞颌关节脱位情况。明确了舍牙囊肿，龋齿，根尖脓肿等病变的部位、病灶大小，及病变对上颌窦和牙槽骨的浸润程度。结论：多层面螺旋CT由于扫描速度快，时间短，因而减少了移动伪影，提高了图像质量。曲面重建能充分显示颌骨病变的全貌，展现每颗牙齿与牙槽骨、上颌窦、鼻腔底、切牙管与下颌管的关系和测量，给牙科治疗、手术及种植提供帮助。     

MSCT-3D重建技术在诊断足骨骨折的应用价值

目的探讨螺旋CT3D成像技术在诊断足骨骨折的重组方式与显示复杂骨折的关系。方法 24例患者进行足部螺旋CT扫描,分别用软组织算法B30 s和骨算法B60 s进行薄层重建,在3 D工作站进行多方位MPR和VR重组。结果多层螺旋CT骨算法重建MPR图像骨窗观察能清楚显示足骨骨折,明确骨折线的走行、骨折片的数目、关节面损伤情况及关节腔内骨折片数目、位置;软组织算法重建MPR图像可清楚显示足跟部肌腱和软组织。结论 MSCT三维重组及多平面重组能准确诊断足骨骨折及软组织损伤,为临床诊治提供清晰及立体的影像资料。