反流性食管炎的X线检查与胃镜检查对比分析

目的 对比分析反流性食管炎的X线特征及胃镜检查结果.方法 185例反流性食管炎患者,行数字胃肠食管气钡双重造影及胃镜检查,观察其X线特征,并与胃镜结果对照分析.结果 185例反流性食管炎的X线表现特征:轻度63例,表现为食管排空缓慢,钡剂滞留,功能性改变,出现异常收缩波;中度112例,表现为食管管壁粗糙,糜烂所致针尖状钡点和走行紊乱之肥厚的黏膜皱襞,可见多发小星状龛影或网织交错样龛影,食管壁轻度变形;重度10例,由于瘢痕形成食管腔变狭窄,狭窄上段食管多扩张、管壁僵硬、粗糙、边缘不规则,狭窄段常有短缩.内窥镜检查:轻度反流性食炎黏膜表面发红、充血,有少许渗出.中度返流性食炎黏膜糜烂,融合成片,有溃疡形成.重度反流性食管炎有明显溃疡伴有狭窄.结论 数字胃肠检查可对反流性食管炎进行全面的观察,但内窥镜则较为理想.     

食管憩室并食管及贲门癌的X线诊断价值

目的：探讨X线钡餐造影对食管憩室并食管及贲门癌的诊断价值。方法：回顾性分析18例经X线钡餐检查、纤维内镜和手术病理证实的食管憩室并食管、贲门癌的X线表现。结果：18例中,单发憩室15例,多发憩室3例,其中最多1例有5个憩室。3个有液气平面。11例食管憩室位于肿瘤之上,7例憩室与肿瘤重叠。食管癌15例,贲门癌3例。憩室X线表现为囊袋状或尖角状钡影突出,肿瘤处黏膜不规则中断破坏、不规则充盈缺损及龛影形成,管腔狭窄,管壁僵硬,扩张度差,对比剂通过缓慢。结论：X线钡餐检查是诊断食管憩室并食管癌、贲门癌最简单、可靠、安全的方法,并能为内镜提供准确的定位,避免憩室穿孔危险。     

食管癌肉瘤X线诊断(附7例报告)

目的：探讨食管癌肉瘤的Ｘ线诊断。材料和方法：经手术病理证实的食管癌肉瘤７例，男５例，女２例。全部病例均行食管低张双对比造影检查。结果：根据Ｘ线表现将７例食管癌肉瘤分成息肉型和浸润型。息肉型６例，表现为腔内带蒂或宽基的肿物，呈分叶状，瘤基底周围的食管粘膜不规则破坏，呈颗粒状隆起或钡点。浸润型１例，表现为管腔狭窄、管壁僵硬、粘膜破坏，可见腔内外软组织肿块。食管癌肉瘤中癌全部为鳞癌、肉瘤中２例平滑肌肉瘤、４例纤维间质细胞肉瘤、１例恶性纤维组织细胞瘤。结论：具有上述Ｘ线表现，结合患者年龄偏大，症状相对较轻，应考虑食管癌肉瘤。     

过氧乙酸腐蚀性食管炎的X线和CT对照研究

目的 探讨过氧乙酸腐蚀性食管炎的X线和CT特征。方法 分析7例过氧乙酸烧伤的消化道X线和CT资料。结果 7例过氧乙酸腐蚀性食管炎主要X线表现为食管中下段管腔严重不规则狭窄，管壁僵硬、蠕动消失，正常黏膜皱襞消失，狭窄以上食管呈不同程度扩张；主要CT表现为中下段狭窄区管壁呈不规则性明显增厚，密度偏低，外缘模糊，周围脂肪线消失，食管上段有不同程度扩张。结论 X线和CT检查可以清楚显示狭窄段部位、范围和程度，食管壁及周围受累情况，以指导临床制定治疗方案。     

小肠类癌一例报告

患者　女 ,47岁。全身乏力 2年 ,加重伴黑便 2月入院。图 1　小肠见长约 5ｃｍ的不规则狭窄段 ,粘膜皱襞破坏、中断、管壁僵硬 ,其邻近肠管扩张受限查体 :贫血貌 ,眼结膜苍白 ,剑下有压痛 ,心脏正常。实验室检查 :血ＨＧＢ72 ｇ/Ｌ ,大便ＯＢ( )。　　小肠气钡双重造影 :于 2组小肠见一长约 5ｃｍ之不规则狭窄段 ,局部粘膜破坏、中断 ,见不规则龛影及小结节状充盈缺损影 ,局部肠管管壁僵硬 ,病变近侧肠管轻度扩张。其邻近肠管亦可见管腔扩张受限 ,管壁欠光整(图 1)。Ｂ超检查 :于左上腹部探及一约 4.6ｃｍ× 2 .8ｃｍ低回声包块 ,边界清晰 ,…     

食道癌肉瘤的X线表现探讨及误诊原因分析

目的探讨食管癌肉瘤的X线学表现，提高对该病的认识。方法回顾性分析5例经病理证实的食管癌肉瘤，5例均行食管钡剂造影和电子纤维胃镜检查，并作病理检查和手术治疗。结果食管钡剂造影显示：病变位于食管中段2例，下段3例。食管腔扩张4例，狭窄1例。管壁柔软4例，僵硬1例。结论息肉型食管癌肉瘤有一定的X线特征性表现，浸润型食管癌肉瘤缺乏影像学特点。     

带蒂息肉状食管癌11例报告

报告带蒂息肉状食管癌１１例。此类食管癌临床症状出现较晚，瘤体呈息肉状突入食管腔内，有小蒂与食管壁相连。Ｘ线表现：局部管腔高度扩张，管壁光整、柔软，腔内有圆形或卵圆形充盈缺损，不同于常见型中晚期食管癌。     

食管克隆病并溃疡穿孔

食管克隆病并溃疡穿孔王兴标张万秀患者男，７２岁。吞咽困难伴胸骨后隐痛３个月余。附图Ｘ线钡餐食管中下段钡剂通过缓慢，管壁僵硬，粘膜皱襞增粗或平坦、消失，部分融合，管腔节段性狭窄、扩张，腹段食管纵形排列呈“卵石”样龛影，其边缘见小斑点状及线形溃疡，下段食...     

食管癌肉瘤的X线表现(附5例报告)

目的:探讨食管癌肉瘤的X线表现,提高对该病的认识。方法:回顾性分析5例经手术病理证实的食管癌肉瘤影像资料。5例均行食管钡剂造影和电子纤维胃镜检查,5例均行手术治疗。结果:食管钡剂造影显示病变位于食管中段2例,下段3例。食管腔扩张4例,狭窄1例。管壁柔软4例,僵硬1例。结论:息肉型食管癌肉瘤有一定的X线特征性表现,浸润型食管癌肉瘤缺乏影像学特征。     

胃肠道原发性淋巴瘤的钡剂造影与CT诊断

目的 探讨胃肠道原发性淋巴瘤的影像学检查方法、诊断、鉴别诊断及与病理的关系。资料与方法 搜集经手术病理或内镜活检证实，并有较完整的消化道造影、部分CT检查资料以及部分手术后标本涂钡摄片的胃肠道恶性淋巴瘤29例，包括胃20例，十二指肠1例，小肠5例，结肠3例。结果上胃肠道气钡双重造影检查，20例胃原发性淋巴瘤中单个较大的不规则形充盈缺损9例，7例形成“牛眼”征；多个大小不等卵石样充盈缺损6例；单个巨大溃疡3例，1例表现为典型的“半月综合征”；多个大小不等浅淡龛影2例；7例胃腔变形，胃壁柔软，蠕动减弱，与以上各类型并存。1例十二指肠原发性淋巴瘤表现为多个大小不等的充盈缺损伴条形龛影。5例小肠原发性淋巴瘤，肠腔狭窄、狭窄段以上肠管扩张2例，3例仅表现为小肠套叠。3例结肠原发性淋巴瘤，肠腔对称性环形狭窄1例，肠腔非对称性充盈缺损伴龛影形成2例。4例胃原发性淋巴瘤CT平扫及增强扫描，1例弥漫性胃壁增厚，增强后胃壁强化明显；3例腔内不规则形肿块，增强后明显均匀强化。4例中3例胃周脂肪间隙欠清晰。2例结肠原发性淋巴瘤CT表现为一侧肠壁见软组织肿块影，增强后明显均匀强化。29例病理组织学结果，非霍奇金淋巴瘤28例，其中B细胞性25例，T细胞性3例；霍奇金淋巴瘤l例。结论 气钡双重造影是诊断胃肠道原发性淋巴瘤主要和首选的检查方法。CT扫描是对气钡双重造影有效的补充，它可以观察胃肠道壁受累的程度和范围、淋巴结转移情况以及肿瘤的TNM分期等。     

数字X线摄影对早期食管癌的诊断价值

目的探讨数字化成像对早期食管癌的诊断价值。方法83例经手术病理证实早期食管癌根据X线检查机型分为数字化X线摄影组(DR组,48例)和普通X线摄影组(对照组,35例),所有患者均作多相钡剂造影,以大口服钡法为主,并摄电子点片及选择性激光输出,X线片摄常规正侧位及左、右前斜位片,电子点片多体位摄取。结果DR组48例中术前发现早期食管癌45例,漏诊3例,诊断准确率为93.3%;对照组35例中术前发现早期食管癌29例,漏诊6例。两组检出率行统计学分析,P<0.01,差异有显著性统计学意义。结论数字化X线机的应用能显著提高早期食管癌的检出率,但胃镜及细胞学检查仍是其必要的补充。     

机械性损伤引致食管黏膜肿胀影像表现

目的探讨机械性损伤导致食管黏膜肿胀的x线表现及食管造影的诊断价值。方法回顾性分析经食管造影和胃镜检查证实的食管黏膜肿胀患者的影像学表现。结果食管黏膜肿胀在x线上表现为纵行条状、梭形或类圆形充盈缺损,边界清楚、光滑,局部食管管壁柔软,扩张良好,黏膜消失或展平,但无破坏及中断。经适当治疗后可短期痊愈,有别于食管占位性病变。结论食管损伤性黏膜肿胀经密切结合病史,食管造影可作出本病的明确诊断和鉴别诊断。     

实时数字采集电影回放技术对食管病变的诊断价值

目的:探讨实时数字采集电影回放技术对食管病变的临床诊断价值。方法:用日本岛津Shmadzu数字胃肠系统(DGIS)检查并诊断40例食管病变患者。患者立位口服钡剂,同时运用实时数字采集技术7.5帧/秒。通过电影回放观察食管双对比像及运动功能像作出诊断。结果:40例中食管癌16例,其中早期食管癌5例,中、晚期食管癌11例;食管癌手术后吻合口狭窄14例;食管憩室2例;食管静脉曲张5例;贲门失弛缓症2例;弥漫性食管痉挛1例。26例经病理及食管镜检查证实,14例术后吻合口狭窄经临床随访证实。主要X线表现:不同病变在双对比像上均有不同程度及性质的轮廓和粘膜改变,在运动功能像上则表现为特征性的运动功能失常。结论:实时数字采集电影回放技术能提供全面的造影信息,在食管病变诊断中有一定的优势及价值,且数字化的造影信息更方便传输与存储。     

Initial experience with magnetic resonance fluoroscopy in the evaluation of oesophageal motility disorders. Comparison with manometry and barium fluoroscopy

The aim of this paper was to assess the diagnostic value of magnetic resonance (MR) fluoroscopy in the study of oesophageal motility disorders and to compare MR fluoroscopy results with those of manometry and barium contrast radiography. Twenty-five subjects referred for dysphagia and three patients in follow-up after pneumatic dilatation of the lower oesophageal sphincter to treat severe achalasia underwent esophageal manometry, barium contrast radiography and MR fluoroscopy. Examinations were performed on a 1.5 T scanner. Dynamic turbo- fast low angle shot (turbo-FLASH) sequences acquired during oral contrast agent administration were used to perform MR fluoroscopy. MR fluoroscopy correctly diagnosed achalasia in nine patients, uncoordination of esophageal body motility in ten and scleroderma oesophagus in one. Diagnostic performance was satisfactory, with a sensitivity of 87.5% and a specificity of 100% in the general depiction of motility alterations. Our work demonstrates that MR fluoroscopic examination in subject affected by oesophageal motility disorders is feasible and can properly depict motility and morphology alterations, achieving correct diagnosis in the majority of cases. Studies on larger populations are necessary to obtain statistically significant results.     

纤维结肠镜与结肠气钡双重造影对结肠癌的诊断价值

目的　分析结肠癌术前纤维结肠镜及结肠气钡双重造影在临床诊断中的应用价值。方法　对 41例结肠癌的X线、内窥镜直视下活检与术后病理诊断符合率进行对比研究。结果　X线诊断符合率 85 .4% ,内窥镜直视下诊断符合率 80 .5 % ,活检诊断符合率 84.6 %。结论　疑为右半结肠癌或疑为左半结肠癌伴有腹腔包块者 ,结肠气钡双重造影优于纤维结肠镜检查 ;对于仅有症状怀疑乙状结肠癌或有结肠息肉疑有息肉恶变的患者 ,纤维结肠镜应为首选。     

Double contrast radiography in the study of the gastric posterior wall (author's transl)]

The authors report their experience about 2,422 examinations with double contrast radiography in the study of the gastric posterior wall. This technique is of great value in the detection, analysis and follow-up of gastric ulcerations. In 54 per cent of cases, the double contrast radiography showed endoscopically proven ulcerations, which where not recognized by standard barium meal technique. The diagnosis of the benign tumours of the posterior wall of the stomach has been also increased bay double contrast radiography. Thus, this technique is recommended for routine examination of the stomach.     

高分辨率食管测压与X线钡餐造影对食管裂孔疝诊断价值的评价

目的 探究X线钡餐造影与高分辨率食管测压对食管裂孔疝的诊断价值.方法 选取50例经手术确诊为食管裂孔疝患者的高分辨率食管测压与X线钡餐造影资料,对比这两种方法对食管裂孔疝的诊断价值.结果 X线钡剂造影检查出食管裂孔疝48例(阳性率96％),未发现食管裂孔疝2例(阴性率4％);高分辨率食管测压检查出食管裂孔疝46例(阳性...     

Double-contrast with insufflated barium-meal technic in the routine radiological study of the esophagus

The results are reported of the esophagus double contrast examination with "Insufflated Barium Meal" technique as first part of the routine upper digestive system radiological examination. This technique gives good double contrast without those artifacts using effervescent powders and without modifying the normal radiological alimentary tract examination established way. The double contrast is administered by a special container with a built-in mouthpiece which allows the simultaneous ingestion of barium suspension and air. The esophageal mucosa can be examined as far as the distal tract where frequently the barium contrast stops using different techniques. Good results in 90% of patients have been obtained. The early detection of inflammatory and tumoral lesions has taken particular advantage in patients sometimes asymptomatic.     

Use of barium in evaluation of disorders of the upper gastrointestinal tract: current status

Biphasic contrast studies are generally advocated as the best current barium examination for the upper GI tract. Two recent prospective blinded trials compared the diagnostic results of a biphasic contrast examination--employing a medium-density barium suspension and glucagon--and endoscopy. Both methods appear to have nearly equal merit for the detection of peptic ulcer and gastric carcinoma. One of the trials demonstrated a relative inability of the barium examination to depict reflux esophagitis other than the severe variety, an inability that had been previously recognized. Earlier Japanese studies showed excellent results from biphasic studies in the detection of early and advanced gastric carcinoma. Because gastric carcinoma may present as a wide variety of lesions, ranging from minute alterations in mucosal relief through ulcers to masses, the values from these Japanese studies also test the sensitivity and specificity of the radiographic examination in demonstrating non-neoplastic lesions of the stomach. Ample data have shown that a radiographic examination compares favorably with endoscopy in the detection of esophageal carcinoma. The usefulness of a radiographic examination as a primary examination if disturbances of esophageal motor function are suspected is generally recognized. A state-of-the-art radiographic examination (ie, a biphasic examination, preferably with drug-induced hypotony) therefore appears to represent an appropriate initial examination in evaluation of most disorders of the upper GI tract. If this examination prompts the slightest suspicion of a malignant tumor, endoscopy should follow for the purpose of obtaining biopsy specimens. Endoscopy is not necessary if duodenal ulcers have been diagnosed by means of radiography; in typically benign gastric ulcers, radiographic follow-up without endoscopy may safely be considered. If in elderly patients multiple small gastric polyps have been detected, endoscopy is not needed. If complaints persist after negative results at radiographic examination, however, endoscopic intervention must be considered. If the complaints suggest reflux esophagitis, the clinician can choose between treatment and endoscopy. In a patient with acute upper GI bleeding, primary endoscopy may be preferred. This diagnostic approach in which endoscopy is employed as complementary to the barium examination is in most parts of the world a cost-effective one. It is also the safest possible option; although endoscopic complications are rare, their absolute number cannot be ignored if every patient had to undergo endoscopy. A biphasic approach with a medium-density barium suspension can be attempted in nearly every patient; if the patient proves unable to cooperate for an optimal double-contrast examination, a single-contrast examination can be performed with the same barium swallowed.     

食管钡餐与CT检查对食管癌手术可切除性的评价

目的：评价食管癌钡餐造影、CT扫描表现对手术切除根治的可行性指导意义。方法：回顾性分析63例经钡餐造影检查、CT扫描及手术病理证实的食管癌患者资料，根据肿瘤的大小、范围、TNM分期，决定是否能行手术切除进行对照研究。结果：钡餐造影在食管癌定位、定性和观察病变范围等方面占优势。CT在食管癌的分期方面优势明显，对TNM分期准确性较高，是指导外科手术是否根治的重要检查方法。结论：食管钡餐造影检查与CT扫描相结合，有利于临床对食管癌患者在术前做出可否手术根治或不宜手术的选择。