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。     

Ureterosigmoidostomy and carcinoma of the colon.

The etiology for development of colon carcinoma associated with ureterosigmoidostomy seems to be related to the urine. The incidence of colon carcinoma associated with ureterosigmoidostomy is 500 times greater than in the normal population, indicating about a 5% life time risk. The development time of these lesions varies from 6 to 50 years postoperatively but it is significantly less in patients more than 40 years old. The possibility exists that colon carcinoma may develop in primary sigmoid urinary diversion conduits or sigmoid internal conduits to either bladder or bowel. No reported bowel carcinoma has developed in an ileal urinary diversion. Followup examination should include stools for blood every 3 months after 2 years, an excretory urogram yearly after 5 years, sigmoid or colonoscopy every 5 years and barium enema every 5 years. If the patient has hematochezia or the excretory urogram demonstrates ureteral obstruction sigmoid or colonoscopy and a barium enema should be done.     

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.     

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。     

改良X线排粪造影临床应用

目的对X线法排粪造影检查技术进行改良,探讨其临床实用价值。方法纳入87例临床诊断为排粪功能异常的女性患者,应用改良技术(包括阴道显影方法和硫酸钡使用方法的改良)进行排粪造影。记录阴道显影的成功率、第1和第2管硫酸钡注射完毕后到达乙状结肠及降结肠的情况、第3管注射完毕后和检查时产生便意的患者数,记录直肠扩张度。结果 87例患者中,阴道改良显影方法的成功率为100%。第1管注入后硫酸钡到达乙状结肠近段者68例(68/87,78.16%),到达降结肠者57例(57/87,65.52%);第2管注入后到达乙状结肠近段者87例(87/87,100%),到达降结肠者81例(81/87,93.10%);第3管注入后产生便意者79例(79/87,90.80%)。排粪检查时87例均产生便意,直肠扩张度为(46.82±5.73)cm。结论改良X线法排粪造影具有很好的临床实用价值,值得推广。     

Laparoscopic colectomy for persistent descending mesocolon in sigmoid colon cancer: A case report

A 55-year-old-man underwent laparoscopic sigmoidectomy for sigmoid colon cancer. Preoperative barium enema showed a slightly medial displacement of the descending colon, and the sigmoid colon was quite long. The operative findings showed that the descending colon was not fused with the retroperitoneum and shifted to the midline and the left colon adhered to the small mesentery and right pelvic wall. Thus, a diagnosis of persistent descending mesocolon (PDM) was made. The left colon, sigmoid colon, and superior rectal arteries often branch radially from the inferior mesenteric artery. The sigmoid mesentery shortens, and the inferior mesenteric vein is often close to the marginal vessels. By understanding the anatomical feature of PDM and devising surgical techniques, laparoscopic sigmoidectomy for sigmoid colon cancer with PDM could be performed without compromising its curative effect and safety.     

The difficulty of urethral anastomosis in sigmoid neobladder--the role of preoperative X-ray of an air-contrast barium enema

BACKGROUND: Sigmoid neobladder (Reddy method) is one of the representative neobladder after radical cystectomy. Occasionally we experienced difficulty on urethral anastomosis in sigmoid neobladder. Here we investigated preoperative X-ray of air-contrast barium enema and clarified what type could be easily anastomosed in sigmoid neobladder. MATERIAL AND METHODS: We performed five cases of total cystectomy with sigmoid neobladder replacement. Of the five, we can easily make a urethral anastomsis in three cases but not easily in other two cases. We investigated sigmoid colon length, it's internal diameter, it's form and it's mobility that was substituted for elevation level of rectosigmoid using preoperative X-ray of air-contrast barium enema. We also studied seventy five cases of X-ray of air-contrast barium enema who visited our hospital with various complaints such as lower abdominal pain. RESULTS: The length of three cases with easily anastomosed were 45.7 cm in diameter other two cases 33.5 cm in diameter.(over all 47.5 cm) The internal diameter were 49 mm and 33.5 mm respectively.(over all 44.4 mm) It was considered that Reddy method was indicated who had at least averaged sigmoid colon length and internal size. Sigmoid colon form were classified into 3 groups (type N. type l and others). There were no difference on colon length regarding sigmoid form, but others was considered to be improper form because significant difference was observed between type N and others in internal diameter. Three cases with easily anastomosed demonstrated a positive correlation of the elevation of the sigmoid colon over promontorium in the air contrast barium enema, other two cases negative. The elevation cases of the sigmoid colon in X-ray of air contrast barium enema had long sigmoid colon than other types.(p < 0.0001) Tha mean length of them was 51.6 cm in diameter. CONCLUSION: Sigmoid neobladder was at least indicated in men who had averaged sigmoid colon length. The sigmoid colon elevation sign in X-ray of air contrast barium enema did not require the measurement of sigmoid colon length and that sign implied good indication for sigmoid neobladder.     

Defining the role of subtotal colectomy in the treatment of carcinoma of the colon.

Seventy-two patients with colon cancer were treated by primary subtotal colectomy, including 23 patients with acute and subacute left colon obstruction. There were two operative deaths and no cases of disabling diarrhea. One death occurred in the group with colon obstruction. Other indications for subtotal colectomy included multiple polyps associated with the primary tumor (32), synchronous carcinomas (15), a previous transverse colostomy for obstruction (8), associated severe sigmoid diverticular disease (2), age less than 50 years with a positive family history (3), adherence of the sigmoid loop to a cecal tumor (2), and metachronous carcinoma (2). There were multiple indications in several patients. Subtotal colectomy has a defined role in a wide variety of clinical settings associated with colon cancer, including management of obstruction of the left and sigmoid colon, particularly if the proximal colon cannot be evaluated before operation by colonoscopy or barium enema. Segmental or regional colonic resections are appropriate if the entire colon can be evaluated before operation and no associated neoplasms are revealed.     

Colonic endoscopy in perspective

Sigmoidoscopy is an easy procedure and should be utilized more frequently. Barium enema examination is incomplete without sigmoidoscopy. Flexible fiberoptic sigmoidoscopy may have a role in the detection of disease of the descending, sigmoid, and rectosigmoid colon. The necessity for its routine usage remains to be determined. The control of colonic polyps by colonoscopy has been the greatest contribution to date by the fiberoptic instrument. Colonoscopy has improved the accuracy of diagnosis of colonic disease and, in certain instances, is helpful in the early detection of cancer of the colon. Colonoscopy complements the use of barium enema examination. Colonoscopy only for the purpose of confirmation of clinical or radiological diagnosis is often unnecessary. While the benefits of endoscopy are obvious, there are definite practical and technological limitations to its use. Complications, although infrequent, are major. Indications for colonoscopy must be clear and findings interpreted with knowledge of the limitations.     

Submucous large-bowel lipomas--presentation and management. An 18-year study.

Gastrointestinal lipomas are rare, but commonest in the colon and rectum, characteristically submucosal and seldom subserosal. An 18-year analysis revealed 17 cases of large-bowel lipoma, 13 presenting with colicky pain, abdominal discomfort, blood-stained feces or rectal bleeding and altered bowel habits and four asymptomatic. The 17 patients had totally 21 lipomas, all submucosal. No patients with multiple lipoma had evidence of lipoma at other sites. The ileocecal valve and cecum were most commonly affected, followed by the rectum, sigmoid colon and descending colon. Tumor size (largest diameter) was 0.5-10 cm, averaging 3.1 cm (3.5 cm in symptomatic, and 1.8 cm in asymptomatic patients). The primary diagnosis (with barium enema, colonoscopy and CT) was lipoma in only five cases, but CT gave the correct diagnosis in all three cases in which it was used. Two lipomas were found in surgical specimens from colorectal malignancy, while nine were misinterpreted as polyps and one as angiodysplasia. In symptomatic patients unnecessary colotomy or colonic resection may be avoidable by colonscopic removal of lipoma.     

A case of vesicosigmoidal fistula secondary to diverticulitis of the colon

A case of vesicosigmoidal fistula secondary to the diverticulitis of colon is reported. A 63-year-old man was admitted to our clinic with the chief complaint of pneumaturia. Cystoscopy revealed an edematous, papillomatous lesion at the left posterior bladder wall. Although multiple diverticulosis of descending and sigmoid colon were demonstrated by barium enema, the presence of a fistula from the intestine to bladder was not confirmed. The presence of fistula was confirmed by detecting the orally administered charcoal in the urine. Resection of sigmoid colon with partial cystectomy was performed. Removed specimen revealed multiple sigmoidal diverticula and a fistula from a sigmoidal diverticulum to bladder through a firm mass. Histological examination of mass demonstrated inflammatory changes. This was the 58th case of vesicosigmoidal fistula due to diverticulitis of colon reported in the Japanese literature.     

Cancer surveillance after ureterosigmoidostomy: colonic microscopic changes

Ureterosigmoidostomy (U-S) is a procedure for diversion of the urinary stream. U-S is associated with a manyfold-increased risk for subsequent development of colonic carcinoma close to the sites of ureteral entry into the sigmoid colon. A surveillance program for colonic carcinomas in U-S patients includes colonoscopic examination of the colon to at least 60 cm and random biopsies of the sigmoid colon distal to the ureteral orifices. In eight patients, a change from sulphomucin to a variable admixture with sialomucin was found in the histologically unremarkable colonic mucosae. When the urinary stream was shunted away from the U-S site in two patients, the mucosal mucin was composed of sulphomucin which is present in normal sigmoid colons. The effect of urine admixed with feces in the sigmoid colon is nonspecific as judged by alterations of the mucosal mucin composition. The U-S patient deserves periodic examinations to detect colonic carcinoma but the histological examination of colonoscopically unremarkable mucosae is not currently contributory toward this surveillance effort.     

Massive lower gastrointestinal bleeding from intestinal varices.

Lower gastrointestinal bleeding from intestinal varices cannot readily be detected at operation; hence, preoperative identification is important. Our experience with six patients having sudden, massive bleeding per rectum from intestinal varices suggests a group of common findings. These patients had cirrhosis, no blood in the stomach or duodenum, characteristic mucosal imprints on barium enema, or direct visualization of varices on sigmoidscopy or colonoscopy. Only two had demonstrable esophageal varices. The diagnosis was confirmed and the site of the varices localized on the venous phase of selective mesenteric angiography in five patients. Varices were located in the duodenojejunum in two, in the cecum and ascending colon in two, and in the rectum and sigmoid colon in two patients. Three patients were treated nonoperatively with transfusion and intraarterial infusion of vasopressin into the superior mesenteric artery; one died. One patient with cecal varices had a right hemicolectomy that controlled the bleeding, but progressive hepatic failure resulted in postoperative death. The remaining two patients had successful decompression of left colonic varices by portasystemic shunt.     

肠系膜下动脉高位结扎后顽固性便秘21例临床分析

目的分析进展期乙状结肠癌或直肠上段癌行根治性切除术后顽固性便秘的致病因素,并总结其治疗经验。方法对江汉大学附属医院胃肠外科2004年1月至2014年12月收治的共21例顽固性便秘病人临床资料进行回顾性分析。结果所有病例既往均为进展期乙状结肠癌或直肠上段癌于外院行根治性手术,原手术均明确记录为肠系膜下动脉高位结扎。术后2~4年(平均3.4年)逐渐出现顽固性便秘,以腹痛、腹胀、大便次数减少及排便困难为主要临床表现。所有病例术前行X线钡剂灌肠造影均显示一共同特征,即结肠脾曲未游离,降结肠未切除,降结肠结肠袋消失,犹如小肠;结肠传输试验均提示为慢传输型,排粪造影均未见出口梗阻。12例再次接受手术,余9例因个人因素放弃手术,仍选择保守治疗(灌肠或口服泻药通便)。所有病人均随访至今,随访时间24~168个月,平均87.8个月,手术组术后效果显著,1年内均恢复正常排便(1~2次/d);而保守治疗组便秘症状无改善。结论乙状结肠癌或直肠上段癌根治术中行肠系膜下动脉高位结扎,而未游离结肠脾曲行包括降结肠、乙状结肠和直肠腹膜返折以上部分肠切除。其后果是部分病人降结肠慢性缺血,结肠形态及生理功能退化,导致顽固性便秘发生(慢传输型便秘)。其有效治疗为再手术行降结肠切除,横结肠-直肠吻合。     

Diagnostic accuracy of double-contrast enema and rectosigmoidoscopy in connection with faecal occult blood testing for the detection of rectosigmoid neoplasms

Four hundred and fifty-eight consecutive subjects with a positive faecal guaiac test when screened for early detection of colorectal neoplasms were investigated with double-contrast enemas and rectosigmoidoscopy (60 cm). The results of these two methods were compared. The radiologists and endoscopists were unaware of the result of each others' examination at the time of their own investigation. Altogether ten subjects with carcinoma in the rectosigmoid area were found. The radiologists and endoscopists each overlooked four of these ten carcinomas and only four of the carcinomas were diagnosed with both methods. Fifty-six of one hundred and seven adenomas were 1 cm or larger in diameter and located in the rectum or the sigmoid colon. Thirteen of the fifty-six adenomas were missed by double contrast enema and ten by endoscopy and only thirty-three adenomas were diagnosed with both methods. Neoplasms in the rectum and the sigmoid colon are sometimes difficult to diagnose with both radiology and endoscopy. Rectosigmoidoscopy (60 cm) should therefore be used as a complement to double contrast enemas if this method is chosen for investigation of a patient with rectal bleeding.     

Giant diverticulum of the sigmoid colon with perforation. Report of a case

We present a case of perforated giant diverticulum of the sigmoid colon. This condition is extremely rare and only a few cases have so far been reported in the literature. Our case involved a 55-year old woman. Diagnosis was easy with barium enema and CT scan examination. Laparotomy revealed a giant diverticulum of the sigmoid colon compressing adjacent structures with signs of inflammation. An en bloc resection of the sigmoid colon, ovary and fallopian tube was performed with primary colon-rectal anastomosis.The post-operative course was uneventful.     

大肠平滑肌肉瘤的诊断和治疗(附9例报告)

目的：探讨大肠平滑肌肉瘤的临床病理特点和外科治疗问题。方法：收集和分析9例大肠平滑肌肉瘤的临床资料。结果：肿瘤位于横结肠2例,降结肠1例,乙状结肠1例,直肠5例。主要临床表现为腹痛、消化道出血、腹部包块及大便不畅、肛门附胀等,内镜和X线钡剂检查为主要诊断手段,病理切片是确诊的关键。治疗以手术为首选,本组手术切除率为78%。结论：大肠平滑肌肉瘤多数位于直肠内。本组直肠平滑肌肉瘤占56%,一旦确诊,应行根治性的手术为宜,对复发及转移的病人,也应采取积极的态度,早期诊断及手术中的无瘤技术是预防复发、提高生存率的关键。     

Use of the barium enema in the diagnosis of acute appendicitis and its complications

The value of barium enema examination in diagnosing acute appendicitis in patients with equivocal findings has been confirmed by our experience with five patients. Cecal spasm, extrinsic compression of the cecum, nonvisualization of the appendix, and partial visualization of the appendix appear to be useful roentgenographic signs, either singly or in combination, in diagnosing acute appendicitis. We have had absolute pathologic correlation between the barium enema findings andthe subsequent clinical course of all the patients in whom we conducted this examination. When performed by an experienced radiologist, the barium enema examination carries no increased risk, and we have seen no complications from this procedure.     

A case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis

We present a case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis. The patient was a 65-year-old male who had been suffering from recurrent abdominal pain with high fever for the past 6 months. He noticed pneumaturia and cloudy urine several times. He visited a doctor complaining of macroscopic hematuria and high fever, and was treated under the diagnosis of acute prostatitis. In our University Hospital cystoscopy showed a papillary bladder tumor. Pathological study of the tumor revealed transitional cell carcinoma, grade II, noninvasive type. Multiple diverticulosis of sigmoid colon was identified with barium enema examination. We performed transurethral resection of the bladder tumor. Three weeks later, the sigmoidovesical fistula was treated by primary resection of the sigmoid colon and wedge resection of the bladder including fistula.