全结肠气钡双重排粪造影的临床应用

目的评价全结肠气钡双重排粪造影能否作为综合诊断便秘患者有价值的影像参考依据。方法利用数字x线胃肠机对260便秘患者进行全结肠气钡双重排粪造影。结果全结肠气钡双重排粪造影诊断出升结肠冗长12例，横结肠冗长8例，降结肠冗长16例，乙状结肠冗长62例，直肠前突59例。其中，结肠冗长合并乙状结肠癌3例，结肠冗长合并降结肠癌2例，结肠冗长合并横结肠癌2例，结肠冗长合并升结肠癌1例。结论全结肠气钡双重排粪造影可一次性了解结肠病变和排粪障碍现状，是一个综合性诊断顽固性便秘的合理方法。     

部位少见骨软骨瘤2例

目的:分析便秘的原因,并评价结肠运输实验、气钡双重灌肠造影与排粪造影对诊断便秘的价值.方法:对136例临床诊断为便秘患者先做结肠运输实验,再做结肠气钡灌肠检查同时同步做排粪造影.结果:结肠运输实验异常者95例;气钡双重灌肠造影异常者89例,排粪造影异常者122例.综合分析结肠运输实验、气钡双重造影与同步排粪造影,诊断为结肠慢运输49例,气钡双重造影有异常(结肠延长或冗长、迂曲、下垂)89例,功能性出口梗阻117例,5例便秘者为精神、意识导致.结论结肠运输实验和结肠气钡双重造影同步排粪造影联合应用,能够更加准确区分结肠慢运输与功能性出口梗阻和结肠形态结构所致的便秘,进一步明确功能性出口梗阻的病因,为临床医生提供可靠的依据,有助于作出更准确、更全面的诊断和制定更恰当的治疗方案.     

结肠双重造影同步排粪造影42例分析

目的：评价结肠气钡双重造影同步排粪造影的可行性。方法：自近两年需做钡灌肠检查加排粪造影检查的108人次中随机抽取42人实施结肠气钡双重造影同步排粪造影,并就各项指标进行对比检验。结果：108例中男22例,女86例;年龄2－73（平均42．93）岁。同步造影42例中男10例,女32例。分别检测组和同步造影组的七种常见疾病的阳性率分别为：直肠前突60．61％和61．90％;直肠黏膜税垂72．73％和64．28％;直肠黏膜套迭46．97和35．71％;耻骨直肠肌综合征,27．28％和37．10％;乙状结肠内疝18．18％和16．67％;盆底下降22．73％和21．40％;骶直分离12．12％和7．14％;小肠疝：0和9％;小肠下垂：0和7％。结论：结肠气钡双重造影同步排粪造影与排粪造影比较排粪障碍病变的显示率大致相同。前者的优点是一次检查可了解结肠病变和排粪障碍病变。     

多排螺旋CT检查对结直肠癌诊断的特殊价值

目的探讨多排螺旋CT检查对结直肠癌诊断的特殊价值。方法回顾性分析笔者所在医院近4年来对均为术前进行螺旋CT检查的术后病理证实的结直肠癌患者56例,总结螺旋CT检查在结直肠癌诊断中的特殊价值,并与结肠镜、气钡双对比造影、B超等3种检查方法进行回顾性分析。结果多排螺旋CT检查与气钡双对比造影、结肠镜对病灶的发现率几乎一致,明显高于B超。多排螺旋CT检查对发现患者浆膜层受侵及腔外肿块、腹腔淋巴结转移、肝转移、腹膜转移等明显高于其他三种检查手段。并且多排螺旋CT（结直肠充气后）扫描于工作站进行三维处理后对受侵肠管范围可以进行大致测量,比较直观显示病变形态范围,为术前手术计划制定提供参考。结论多排螺旋CT检查对结直肠癌诊断具有特殊价值,应作为结直肠癌术前必备检查之一。     

结肠脾曲综合征10例诊治体会

目的:探讨结肠脾曲综合征患者的临床表现、诊断方法及治疗手段.方法:对10例结肠脾曲综合征患者的临床资料进行回顾性分析.结果:患者临床表现为反复发作的腹痛、腹胀和便秘,易误诊;有8例病人通过X线钡灌肠造影诊断,有2例通过螺旋CT气钡双重成像诊断,均可显示结肠脾曲过高,迂曲成角甚至扭转,合并横结肠过长; 10例病人通过手术松解结肠脾曲,切除冗长结肠都取得良好疗效.结论:结肠脾曲综合征是由于先天性结肠脾曲固定点过高、横结肠冗长、横结肠左角狭窄的疾病 ,易误诊,诊断主要依据X线钡灌肠造影,手术是该病的有效治疗手段.     

16层螺旋CT对结肠腺癌和粘液腺癌的诊断价值

<正>结肠癌的常用检查方法有结肠气钡双重造影,结肠内窥镜,它们能够较好的观察结肠癌腔内情况;近些年,随着高分辨率多层螺旋CT的发展,结肠癌CT扫     

气钡双重造影在结肠癌诊断中的应用价值

为探讨气钡双重造影在结肠癌诊断中的应用价值,回顾经气钡双重造影检查诊断为结肠癌的40例患者X线征象资料,并与手术及病理检查结果进行对比分析。结果显示,术后病理检查诊断,结肠癌39例,肠结核1例,气钡双重造影X线摄片诊断准确率为97．5％（39／40）;39例经病理检查证实为结肠癌的患者气钡双重造影X线摄片显示,肿瘤位于升结肠6例,肝曲8例,横结肠4例,脾曲2例,乙状结肠19例,与手术所见完全一致,准确率为100％。结肠癌气钡双重造影主要X线表现为软组织肿块、充盈缺损、腔内龛影、肠壁增厚、肠管狭窄、边缘僵硬、肠黏膜破坏中断。结果表明,气钡双重造影诊断结肠癌准确率高,而且操作简单、易于掌握,在基层医院具有较高的应用价值。     

腹腔镜结直肠手术肿瘤定位方法的临床研究

目的:探讨腹腔镜结直肠手术肿瘤的定位方法。方法:2009年12月至2013年12月收治58例结直肠肿瘤患者,其中22例于术前2 h内行亚甲蓝定位,12例术前行钛夹定位,4例术前行气钡双对比造影检查,20例术中结肠镜定位。准确定位后行腹腔镜结直肠癌根治术或局部肠段切除术。结果:2例行术前亚甲蓝标记患者因腹腔面肠壁浆膜无亚甲蓝染色而无法定位,术中行结肠镜检查定位;1例行术前钛夹定位患者腹部平片见钛夹位于右下腹,结合肠镜肿瘤距肛门的距离,确定病变位于乙状结肠;1例行术中结肠镜检查准确定位患者因结肠镜检查致使小肠及结肠胀气,无手术空间,中转开腹;4例患者行气钡双对比检查准确定位。结论:腹腔镜结直肠术中可结合直肠指诊对肿瘤进行定位,直肠指诊不能触及的肿物,通过术前行亚甲蓝、钛夹标记、气钡双对比造影及术中肠镜检查对结直肠肿瘤进行定位,术中可准确、快速定位病灶,缩短手术时间,减少并发症的发生,同时避免误切肠管及保肛失败。     

中药泻剂加造影剂行结肠气钡双重造影的临床应用价值

为探讨番泻叶、大黄浓缩液加芦荟粉配合结肠气钡双重造影的临床价值，回顾采用此方法造影（治疗组，40例）和常规气钡双重造影（对照组，40例）的患者资料，对比分析两组造影后钡气排出情况。结果显示，治疗组彻底排出者29例，大部分排出者10例，少量排出者1例，无不能排出者，总灌入量为16000ml，总排出量为14700ml，总排出率为91．9％；对照组无彻底排出者，大部分排出者11例，少量排出者17例，不能排出者12例，总灌入量为16000ml，总排出量为5400ml，总排出率为33．8％。治疗组钡气排出效果明显优于对照组，P〈0．05。且治疗组不良反应比对照组轻。结果表明，番泻叶、大黄浓缩液加芦荟粉配合结肠气钡双重造影，能刺激肠道蠕动，促进肠道内注入的钡和气加速排出，大大减轻造影后的腹部不适感。     

多层螺旋CT在结肠直肠肿瘤诊断中的临床应用研究

目的:研究和评价多层螺旋CT(multi-spiral computed tomography,MSCT)在结肠直肠肿瘤诊断中的临床应用和价值。方法:收集仁济医院普外科2004年至2009年接受手术的326例结肠直肠肿瘤病人。①选取其中284例和264例分别进行MSCT结肠定位、定性诊断,并与X线钡剂灌肠及电子肠镜检查的结果进行对比;②取其中75例结肠癌病人同时接受常规放射剂量与低放射剂量结肠MSCT检查,并比较两者在结肠成像上的差别;③运用低放射剂量CT对84例结肠肿瘤病人进行TNM分期,并与其术后病理结果进行对比分析。结果:①在264例同时接受MSCT与钡剂灌肠的结肠直肠肿瘤病人中,MSCT的定位准确率为96.2%(254/264),钡剂灌肠的定位准确率为89.4%(236/264);284例同时接受MSCT与电子肠镜检查的结肠直肠肿瘤病人的MSCT的定位准确率为94.0%(267/284),而其电子肠镜的定位准确率达90.1%(256/284)。可见,MSCT对结肠直肠肿瘤的定位准确率高于钡剂灌肠和电子肠镜。在结肠直肠肿瘤定性诊断中,结肠直肠MSCT的诊断率(87.5%)高于钡剂灌肠(85.2%),而低于电子肠镜检查(95.4%),但差异尚无统计学意义。②对75例同时接受常规剂量结肠CT和低剂量CT检查病人的的成像质量进行对比,结果显示两者无明显差异(P0.05)。③低剂量结肠CT在结肠术前TNM分期诊断准确率为79.8%,与术后病理比较,并无统计学差异(P0.05)。④术后对32例结肠直肠肿瘤病人随访2年,MSCT发现其中6例出现肿瘤复发和转移。结论:MSCT在结肠直肠肿瘤的术前定位、定性及术前分期诊断中具有较高的准确率,并在术后随访中发挥重要作用。低剂量结肠CT的放射剂量大幅降低,安全性提高,结合仿真结肠镜和展平显示技术能基本满足结肠直肠病变的筛查和分期要求。     

Pre-operative or postoperative colonic examination for synchronous lesions in colorectal cancer

A review of 130 consecutive large bowel examinations at which a cancer of the colon or rectum was diagnosed has been undertaken. Of 50 patients examined by colonoscopy, the whole colon was seen in only 21 (42 per cent) and almost half of these had a tumour in the caecum or ascending colon. In most cases, an incomplete examination was the result of narrowing of the lumen by the tumour preventing passage of the endoscope. Of 80 patients examined by double contrast barium enema, the entire length of the colon was visualized in 83 per cent but the quality of the examination was sufficient to confidently exclude synchronous neoplastic lesions in only 51 per cent. The incidence of synchronous cancer in this series was within the expected range, although two such cancers were not detected until laparotomy, but the incidence of synchronous adenomas was two-thirds of the expected number in colonoscopy patients and one-third in those examined by barium enema. It is concluded that, in patients with known colorectal cancer, preoperative investigation is unreliable for the detection of all synchronous neoplasia and that patients should have postoperative colonoscopy.     

Routine double contrast barium enema and fiberoptic colonoscopy in the diagnosis of colorectal carcinoma

The diagnostic efficacy of routine double-contrast barium enema and fiberoptic coloscopy for detection of cancer was retrospectively studied in 303 patients consecutively operated for colorectal adenocarcinoma in a 52-month period from January 1980. Double-contrast barium enema was performed in 180 patients with 184 carcinomas, 157 (85%) of which were revealed by this examination. The detection rate of carcinoma according to site was 89% between cecum and descending colon, 92% in sigmoid colon and 71% in rectum. Fiberoptic colonoscopy was done in 176 patients with 181 carcinomas, 163 (90%) of which were detected by the endoscopical examination. The detection rate of carcinoma according to site was 86% between cecum and descending colon, 90% in sigmoid colon and 95% in rectum. The two methods were equally effective in detecting carcinoma of the colon. Colonoscopy was superior to barium enema in detection of rectal carcinoma.     

多排螺旋CT结肠成像术在结直肠肿瘤性病变检出诊断中的应用

目的探讨64排螺旋CT结肠成像术（CTC）在检出结直肠肿瘤性病变中的应用价值。方法对132例疑诊结直肠病变患者进行CT扫描、结肠气钡双重造影（DCBE）检查、结肠镜检查,将CT数据传至工作站后处理。获取CTC图像,将所得CTC、DCBE的检查结果与结肠镜及手术病理结果进行对比分析。结果CTC检出病变的敏感度96．49％、特异度90．91％、准确率95．59％。DCBE检出病变的敏感度91．23％、特异度72．73％、准确率88．24％。两种检查对病变检出差异无统计学意义（χ2=0．566,P=0．319）。CTC检查直径≤5．0mm病变的敏感度80．95％、特异度86．96％、准确率84．09％。DCBE对直径≤5．0mm病变检出的敏感度57．14％、特异度69．56％、准确率63．64％。两种检查对直径≤5．0mm病变检出差异无统计学意义（χ2=0．679,P=0．422）。CTC检查直径5．1～9．9mm病变的敏感度91．67％、特异度100％、准确率94．12％;DCBE检出直径5．1～9．9mm病变的敏感度75．00％、特异度80．00％、准确率76．47％。两种检查对直径5．1～9．9mm病变检出的差异无统计学意义（χ2=0．631,P=0．374）。CTC、DCBE检出直径≥10．0mm病变的敏感度、特异度、准确率均为100％。结论CTC是一种无创性检查方法,在结直肠肿瘤性病变检出的应用中具有一定优势。     

Why barium enemas fail to identify colorectal cancers

Background: The aim of the present study was to determine the cause and clinicopathological factors associated with the failure of barium enemas to detect colorectal cancers. Methods: A histopathological database was used to identify all patients with a diagnosis of colorectal cancer between 1991 and 1995. These records were matched with the records from patients who underwent barium enema examinations between 1990 and 1995. Those patients who had a colorectal cancer histologically diagnosed within 24 months of a barium enema in which no car­cinoma was seen, were identified. Where possible the radiology was reviewed. Failure to identify a carcinoma was then attributed to either simple failure, technical, interpretive or perceptive difficulties. Results: There were 967 patients with colorectal cancers treated in Christchurch Hospital during the study period 1991–1995. Matching of these patient details with all barium enema records revealed 313 patients who had barium enemas and histologically proven colorectal cancer. There were 21 (6.7%) patients in whom a carcinoma was missed. Of these, 18 had a barium enema within 8 months of surgery, and three were performed outside this timespan (15, 18 and 28 months, respectively). On review, 11 carcinomas could not be identified (nine due to technical error: poor coating (n = 1), overlapping loops (n = 3), single‐contrast enema (n = 4), faecal residue (n = 1)); and seven could be seen on review of the films (two interpretation errors, one technical and perceptive error, and four perceptive errors). In three cases films could not be found for review. In 16 of the 21 missed lesions the patient had a double‐contrast barium enema (DCBE) while five patients had single‐contrast barium enema (SCBE). The site and stage of missed tumours is presented. Conclusions: The most common reason for missed tumours was technical. The percentage of missed tumours in each region of the bowel correlates with the known incidence of tumours in each region and with a normal Dukes stage distribution, except in the caecum where the number of missed lesions was higher than expected.     

数字化胃肠机结合改良低张双对比结肠钡灌肠技术的临床应用

目的 提高结肠双对比钡灌肠检查效果。方法 采用摇篮式全数字化胃肠机、新一代口服全肠灌洗液作肠道准备、自制的一次性灌肠套进行结肠的双对比钡灌肠检查。结果 64例行结肠双对比钡灌肠检查者．盲、升结肠内无或少粪渣者达93．8％．所有患者都能顺利完成检查。结肠双对比钡灌肠检查优良率与可供诊断率分别为80．0％和95．0％。结论 应用数字化胃肠机和改良的结肠低张双对比钡灌肠技术．其操作简便．双对比效果好，能充分显示结肠粘膜面的情况，提高病灶的检出率和正确诊断率．是一种简便、高效的检查方法。     

Double contrast barium enema and flexible rectosigmoidoscopy: a reliable diagnostic combination for detection of colorectal neoplasm

The efficiency of double contrast barium enema and flexible rectosigmoidoscopy (to 60 cm) in the assessment of patients with a positive Hemoccult II test in a randomized screening study for colorectal neoplasms was evaluated. A positive test was present in 625 patients, of whom 530 had a complete enema and rectosigmoidoscopic assessment. A carcinoma was diagnosed in 26 and an adenoma greater than or equal to 1 cm in diameter in 71. As a control, 323 patients with a negative assessment repeated the Hemoccult II test and of these 67 had a positive second test, of whom 55 underwent colonoscopy. One carcinoma (Dukes' A) and two adenomas greater than or equal to 1 cm in diameter were diagnosed. The efficiency of the assessment was also checked by rescreening the whole group 1-2 years after the first study and by continuing follow-up. It was found that two more carcinomas and one adenoma greater than or equal to 1 cm in diameter had been overlooked at the primary assessment. The sensitivity for neoplasms greater than or equal to 1 cm in diameter at the primary assessment was 72 per cent for double contrast barium enema and 86 per cent for rectosigmoidoscopy. The sensitivity for the combined methods was 94 per cent and the specificity was 99 per cent. The combination of double contrast barium enema and rectosigmoidoscopy in the primary assessment of patients with a positive Hemoccult II test gives an acceptable result and immediate retesting of those with a negative assessment is not necessary.     

Increasing incidence of right-sided lesions in colorectal cancer.

One hundred ninety-eight patients with 211 cancers of the colon and rectum underwent elective resection at the University of Vermont College of Medicine during the five year period 1971 through 1975. Analysis of this series demonstrated that 35 per cent of all cancers were located in the cecum and ascending colon, that a similar percentage were classified as Dukes' A cancers, that a synchronous cancer was present in 5.5 per cent of the patients and that diagnosis by rectal examination and sigmoidscopy was possible in only 32 per cent of the patients. Comparison of these results with published data during the past thirty years indicate that there is an increasing incidence of carcinoma of the right colon with an associated decrease in the incidence of carcinoma of the sigmoid colon and rectum. It is recommended that patients be screened by examination of the stool for occult blood rather than by rectal examination and sigmoidoscopy so that these proximal lesions can be diagnosed at an earlier stage. Preoperative evaluation of patients with distal colorectal cancer should include double contrast barium enema examinations and colonscopy to rule out synchronous right-sided lesions.