回盲部结核74例的诊断与外科治疗

目的：总结回盲部结核的诊断与外科治疗经验。方法：回顾性分析我院手术治疗回盲部结核74例的临床资料。结果：钡剂灌肠透视确诊率63．8％（30／47）；纤维结肠镜检＋活组织检查确诊率为100％（74／74）。回盲部结核术前确诊率低为68．9％（51／74）。术前非静止期结核给予抗结核药物治疗。53例行右半结肠切除术（彻底切除病变肠段）；15例行回肠末段与横结肠吻合的捷径手术；6例行回肠末段造瘘术。68例切口一期愈合，6例切口感染，经1～3周换药痊愈。结论：回盲部结核需应尽早明确诊断，与回盲部癌相鉴别；积极的手术治疗，配合系统的药物治疗，预后良好。     

阑尾恶性肿瘤7例诊治体会

目的探讨阑尾恶性肿瘤的病理特点、临床表现及诊治要点。方法本文分析1983年至2006年,我院7例阑尾恶性肿瘤患者的临床资料。结果7例阑尾恶性肿瘤患者中阑尾类癌5例,阑尾腺癌2例,7例患者均行手术治疗,其中行单纯阑尾切除术3例,回盲部切除术2例,右半结肠切除术2例。结论阑尾恶性肿瘤临床上较少见,诊断困难,术前常易误诊为阑尾炎,且二次手术率较高,因此,对术中可疑者应快做快速病理切片予以确诊,并选择适当的手术方式。     

盲肠憩室炎的误诊原因分析与急诊处理

目的探讨盲肠憩室炎的临床诊断与治疗。方法对我院近10年收治的27例盲肠憩室炎临床资料进行回顾性分析。结果8例以盲肠憩室炎收入院，4例入院后通过放射学检查确诊，15例误诊为急性阑尾炎，误诊率为55．6％。保守治疗4例，手术23例，其中憩室内翻埋入术2例，回盲部切除术20例，右半结肠切除术1例。结论应提高对盲肠憩室炎的认识，提高入院诊断的正确率。B超、CT和钡灌肠检查是有效诊断手段。炎症轻者保守治疗多可治愈，手术方法以回盲部切除为主。     

回盲部肿瘤致急性阑尾炎14例分析

目的探讨回盲部肿瘤致急性阑尾炎误诊、漏诊的原因及防止措施。方法 2010-08—2015-08,共手术治疗急性阑尾炎1 218例,其中14例急性阑尾炎为回盲部肿瘤所致,对14例患者的临床资料进行回顾性分析。结果 14例患者中12例在术中发现为回盲部肿瘤,行I期右半结肠切除术;2例患者术后发生阑尾残端瘘,经影像学及肠镜检查确诊为回盲部肿瘤,限期行右半结肠切除术,术后均恢复良好。病理学检查结果提示:均为急性化脓性阑尾炎。回盲部高分化腺癌5例,中分化腺癌4例,低分化腺癌2例,黏液腺癌1例。误诊主要原因为:病史询问不详细、体格检查不全面、辅助检查不完善、患者典型的阑尾炎症状和体征掩盖了回盲部肿瘤的症状和体征及术中未探查回盲部。结论回盲部肿瘤致急性阑尾炎时,临床表现以急性阑尾炎为主,易出现误诊和漏诊。对于有慢性阑尾炎反复发作病史且伴有贫血、消瘦、腹泻和粘液血便并大便潜血阳性的中老年患者,应警惕回盲部肿瘤的可能,及时完善超声等影像学检查,以减少回盲部肿瘤的误诊、漏诊率。     

原发性小肠恶性肿瘤的诊治

目的 探讨原发性小肠恶性肿瘤的诊断与治疗。方法 对我院1990年1月至2003年1月收治的88例原发性小肠恶性肿瘤的临床资料进行回顾性分析。结果 术前确诊36例，误诊52例，误诊率为59．1％。主要临床表现为腹痛66例(75．0％)、肠梗阻56例(63．6％)、腹部肿块51例(58．0％)及大便隐血或便血48例(54．5％)。病理类型：腺癌49例(55．7％)，平滑肌肉瘤22例(25．0％)，淋巴瘤12例(13．6％)，脂肪肉瘤5例(5．7％)。病变部位依次为：空肠36例(40．9％)，回肠34例(38．6％)，十二指肠18例(20．5％)。结论 原发性小肠恶性肿瘤术前诊断困难，误诊率高。为减少误诊，提高治愈率：①要提高对原发性小肠恶性肿瘤的高度警惕性，全面掌握和分析临床资料；②对40岁以上有不明原因的腹痛、消瘦、贫血、消化吸收功能紊乱、腹部肿块等的患者，进行有针对性的辅助检查，如胃肠道气钡双重造影、纤维内窥镜、B超、CT和肠系膜上动脉造影等，可提高原发性小肠恶性肿瘤的检出率；③不能排除小肠恶性肿瘤时，应及时剖腹探查，以免延误诊断治疗；④治疗以手术切除为主，术后辅助化疗，可改善预后。     

原发性十二指肠恶性肿瘤84例临床分析

目的：探讨十二指肠恶性肿瘤的常见临床表现、诊断及治疗。方法：回顾性分析1995～2002年84例原发性十二指肠恶性肿瘤的临床资料。结果：肿瘤主要分布于十二指肠第二段(61／84)，病理类型以腺癌为主(72／84)，位于乳头附近的肿瘤常引起胆道梗阻，其他部位的肿瘤主要表现为高位肠梗照或消化道出血。胃镜确诊率达到78．9％．十二指肠镜确诊率达到83％，CT确诊率达到84％。50例行胰十二指肠切除，20例行短路手术，7例行局部切除，手术切除率为70%(57/81)。胰十二指肠切除术并发症发生率18％，其他术式较少发生并发症。结论：十二指肠恶性肿瘤症状无特异性．内镜和CT是重要的诊断手段．胰十二指肠切除术是主要治疗术式。     

回盲部肿瘤并急性阑尾炎的诊断和治疗

目的总结回盲部肿瘤并急性阑尾炎的诊断要点,防止误诊、漏诊。方法对16例回盲部肿瘤并急性阑尾炎患者的临床资料进行回顾性分析。结果 16例患者均以急性阑尾炎入院。其中12例患者在术中发现回盲部肿瘤,行I期右半结肠切除术。另外4例患者阑尾切除后,临床症状未明显缓解。经肠镜检查确诊为回盲部肿瘤,择期行手术治疗,术后均恢复良好。结论回盲部肿瘤并急性阑尾炎时,临床症状以急性阑尾炎表现为主,易出现误诊和漏诊。术前详细询问病史,认真进行体检,完善超声等检查,以减少回盲部肿瘤漏诊率。     

三原发结直肠癌长期生存二例

患者 例1 男性，59岁。因乏力2月，黑便3周于2005年5月15日入院。患者因纤维结肠镜检查提示直肠腺癌，于1978年10月27日行直肠癌根治术（Miles术），术后病理诊断为直肠腺癌侵及肠壁全层，送检淋巴结未见癌转移，两切缘未见癌组织。术后予以化疗，于1978年12月8日出院。1987年4月11日年因发现右侧腹部包块行钡灌肠检查诊断为回盲部肿瘤，     

原发性十二指肠肿瘤86例的诊断和治疗

目的:探讨原发性十二指肠肿瘤的诊断及治疗方法。方法:回顾分析26年间收治的86例原发性十二指肠肿瘤患者的资料，其中良性18例，恶性68例。诊断依赖于肠镜和影像学检查，治疗有赖于外科切除术。结果:临床表现包括胃肠道症状、胆道梗阻症状和非特异性的发热贫血及消瘦等。术前确诊率十二指肠镜为91.3％，气钡造影为88.5％，磁共振胰胆管造影为84.6％，B超为31.9％，CT为51.9％，磁共振为76.2％，ERCP为100%；联合十二指肠镜、气钡造影检查确诊率可达95.0％。71例发生于十二指肠降部。18例原发性十二指肠良性肿瘤全部被切除，5年生存率为92.3％；68例原发性十二指肠恶性肿瘤中35例行胰十二指肠切除，8例行十二指肠节段切除，切除率为63.2％；切除术后5年生存率为31.0％；25例行旁路手术，5年生存率为0。结论:原发性十二指肠肿瘤缺乏特异性症状，经内镜、气钡造影等联合检查，可提高术前阳性诊断率。对良性肿瘤可行十二指肠节段切除或局部切除，恶性肿瘤首选胰十二指肠切除术。     

右半结肠癌误诊6例报告

我院近历年来收治右半结肠癌22例，误诊6例，男5例，女1例，年龄叙岁～76岁。其中误诊为阑尾脓肿3例，慢性阑尾炎2例，慢性胆囊炎1例。6例患者均有右下腹或右上腹胀痛伴发热，其中3例伴消瘦、贫血及大便习惯改变，并们及右下腹包块，有触痛。行X线钡灌肠检查《例，其中提示回盲部肿瘤2例（误诊为阑尾脓肿），结肠肝曲通过受阻1例（误诊为慢性胆囊炎），另1例未见异常。误诊时间2个月～6个月。经手术确诊为回盲部癌5例，结肠肝曲癌1例，均行右半结肠切除术。右半结肠癌常继发感染，引起腹痛、发热及白细胞增高，易误诊为阑尾脓肿、阑尾炎或…     

影像学检查在膀胱肠瘘中的诊断价值

目的:探讨影像学检查在膀胱肠瘘中的诊断价值。方法:回顾分析12例各型膀胱肠瘘的诊断资料,其中膀胱镜检查10例,KUB加IVP9例,膀胱造影8例,钡剂灌肠7例,B超9例,CT7例,MRI3例。结果:KUB加IVP发现3例可疑,无一例确诊;膀胱造影3例因发现造影剂进入肠腔而确诊,3例可疑;钡剂灌肠1例确诊,1例可疑,5例发现结肠内原发病;CT发现例5膀胱壁局部增厚毛糙,其中3例发现膀胱壁外肿块,3例发现膀胱内积气;膀胱镜结合瘘管造影5例确诊,1例可疑。结论:单一检查确诊率较低,对检查结果要综合分析,CT、膀胱造影简便易行,可以作做为初选的手段,膀胱镜结合瘘管造影,可以进一步确定瘘的位置,尿内异物的患者首选钡剂灌肠,CT检查可以为手术方案的选择提供可靠的依据。     

Hydrostatic reduction of intussusceptions caused by lead points

It is generally accepted that an intussusception caused by a lead point will not be reduced by hydrostatic barium enema. This was reported several years ago, and has continued to be a consistent finding, prompting us to attempt hydrostatic barium enema reductions of recurrent intussusceptions in infants and children and also in older children with a first intussusception. However, in the last 9 years we have treated five children whose ileocolic intussusceptions were caused by lead points but which were reduced by hydrostatic barium enema. The histories and physical examinations were not any different than those of the average pediatric patient with an intussusception. The ileocolic intussusceptions diagnosed by barium enema were reduced with adequate reflux of barium into the terminal ileum. However, a residual and persistent filling defect in the colon or ileocecal area made laparotomy mandatory. In all five cases, a lead point was found and resected. This experience has suggested to us that a residual intraluminal filling defect in the barium column following what appears to be adequate flooding of the terminal ileum should be interpreted as a lead point, and an indication for a laparotomy.     

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。     

Adult intussusception with cecal adenocarcinoma: Successful treatment by laparoscopy-assisted surgery following preoperative reduction

We report a case of adult intussusception caused by cecal adenocarcinoma that was treated by laparoscopyassisted ileocecal resection following reduction by contrast enema and preoperative colonoscopy.A 68-yearold male with cecal cancer was admitted to our hospital because of colicky abdominal pain after taking a laxative.His abdomen was distended,and a mass was palpable in the right upper quadrant,which appeared as a target-or sausage-shaped lesion by ultrasonograhpy and computed tomography.A contrast enema using water-soluble material showed a cup-shaped filling defect characterized by intussusception in the ascending colon.This round defect with a clear margin was pushed gradually back into the cecum by the enema pressure.Re-occurrence of the intussusception is easilyreleased by colonoscopy.We performed laparoscopyassisted ileocecal resection of a protruding tumor measuring 6.5 cm × 5.0 cm × 3.5 cm from the cecum,with D3 lymph node dissection.Histological examination revealed a well-differentiated adenocarcinoma that had invaded the serosa without permeating the lymphatic or venous capillaries,as well as lymph node metastasis.The postoperative course was uneventful,and the patient has been well without evidence of disease recurrence for 5 years following the operation.Preliminary reduction of adult colonic intussusception before surgical resection is therefore an option in cases of an early and correct diagnosis of intussusception.     

肠结核的诊断及外科治疗37例报告

目的探讨肠结核诊断及内、外科治疗方法。方法回顾性病例分析及文献综述。结果我院１９８３～１９９７年共收治３７例肠结核病例,其中２６例行钡餐阳性率１００％（２６／２６）、钡灌肠２４例阳性率１００％（２４／２４）和纤维结肠镜１７例阳性率９４１％（１６／１７）。单纯内科治疗２１例,１６例因并发症或误诊接受外科治疗,１３例切除病变肠管,３例行开腹活检或穿孔修补术。内科治疗组,抗结核时间２０个月,复发４例;切除病变肠管的１３例患者平均抗结核时间１０个月,没有复发;行开腹活检或穿孔修补的３例患者抗结核时间１９个月,１例复发。结论钡餐、钡灌肠、纤维结肠镜是较为有效的检查方法,对于伴有腹部并发症的患者及早积极采用外科手术治疗切除病变肠管及术后抗结核治疗,从治疗时间、治疗复发等方面可能优于单纯内科保守治疗。     

Ultrasound-guided hydrostatic reduction for the treatment of idiopathic intestinal invagination

The more extended conservative treatment in intussusception consists of the accomplishment of fluoroscopy guided neumoenema. The development of the echography has allowed to introduce this as alternative in diagnosis and treatment of intussusception. Our objective is to analyze the therapeutic value of echography during resolution of intussusception with saline solution enema in pediatric patients. Intestinal intussusception was diagnosed in 183 patients by echography during a period of 7 years. Patients are classified in three groups according to treatment by means of opaque enema, radioscopy guided neumoenema or echography guided hydrostatic reduction enema. The results of the three series are analyzed: rate of failure of the procedure, the recurrences or the presence of complications. We exclude n = 18 patients that were operated on directly after the diagnosis. The reduction rate was 81.25% (9/16) with opaque enema; 94.6% (103/110) with neumoenema and 96.4% (27/28) with echography guided saline enema. Complications appeared in n = 2 cases of intestinal perforation, 1 with barium and 1 with air 2. Recurrences were n = 3, n = 2 with neumoenema and n = 1 with echography guided enema. Echography guide saline enema has a high security and effectiveness (96.4%), similar to the other methods, avoiding the exposition to ionic radiation. The technique is safe and it does not increase the rate of recurrences.     

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.     

儿童特发性便秘的诊断(86例临床分析)

目的：探讨儿童特发性便秘的诊断。方法：对2000年6月至2002年10月经结肠造影和肛门直肠测压诊断的86例特发性便秘的临床资料进行分析。结果：男44例，女42例，婴儿期9例，幼儿期66例，学龄期11例。结肠造影检查86例，其中未见异常75例，直肠扩张5例，乙状结肠冗长3例，直肠扩张合并乙状结肠冗长3例；肛门直肠测压44例，其中未见异常16例，排便弛缓反射异常12例，直肠肛门抑制反射(RAIR)异常22例，感觉功能障碍10例。获得随访68例，其中痊愈47例(69．1％)，好转11例(16．2％)，无效10例(14．7％)。结论：结肠造影结合肛门直肠测压检查可提高儿童特发性便秘的诊断。     

Changes in the diagnosis and therapy of invagination

The alterations in diagnosis and therapy of intussusception in infants is described in 155 cases from 1978-1989. The primary diagnostic procedure is the abdominal sonography. It is followed to 1988 the attempt of hydrostatic reduction by barium enema and now the pneumatic reduction. The rate of success with conservative treatment was finally over 80%. Primary operative treatment is only necessary in the rare cases with signs of perforation of intestine or of peritonitis.     

肠道间质瘤10例临床分析

目的:探讨肠道间质瘤的临床表现、病理类型、诊断及治疗措施。方法:回顾性总结长海医院1991年至2001年经手术治疗并经病理证实了的10例病例。结果:主要表现为:阵发性腹痛、腹胀、消化不良、便血、腹部或直肠包块。病理类型:良性间质瘤2例、恶性间质瘤8例。结论:肠道间质瘤表现无特殊性、易误诊,内镜和X线钡灌肠检查是术前常用的方法,腹部核素扫描、超长型电子小肠镜可提高诊断率。治疗上应采取以手术为主的综合治疗。