肛管直肠损伤的诊断及治疗

目的　探讨肛管直肠损伤的诊断及治疗方法。方法　对诊治的 2 9例肛管直肠损伤病例的临床资料进行回顾性分析。结果　 2 9例均手术治疗 ,全部治愈 ,并发症发生率为 10 .3%。结论　早期诊断与及时手术治疗是提高肛管直肠损伤疗效的关键     

排粪造影及其临床应用

目的应用排粪造影方法对排便困难者进行造影分析，以期提高对排便困难者影像表现的认识。方法回顾性分析48例排粪造影的X线片表现，并使用卢氏标准进行测量。结果盆底痉挛综合征20例，直肠前突16例，直肠内套叠18例，肠疝6例，肛管息肉2例，肛瘘2例。结论排粪造影方法是目前对排便困难者最佳的影像检查方法，对其病因有重要诊断价值，明显优于传统钡灌肠、肠镜检查，并对检查方法、排粪机制等进行了讨论。     

小儿直肠肛管测压的护理体会

直肠肛管测压是通过气囊法或灌注法来了解肛门直肠动态的一种新的检测方法。可以检查直肠感觉功能、直肠顺应性和肛门内外括约肌压力、直肠肛管松弛反射、肛管高压区压力及长度等 ,提供反映直肠和肛门内外括约肌功能的客观指标 ,为判定便秘程度和类型提供可靠依据。目前 ,据国内外报道对诊断先天性巨结肠症的阳性率已达到 90 %以上[1] ,已经成为先天性巨结肠症的特异性诊断方法。 2 0 0 2年我院对 2 0 0例便秘患儿进行了肛门直肠测压 ,现将具体检测方法和护理体会介绍如下。1　临床资料1 .1　一般资料　 2 0 0 2年 3月～ 2 0 0 3年 3月我院…     

肛管超声对肛管直肠疾病的诊断价值

肛管超声对肛管直肠疾病的诊断价值上海长海医院肛肠外科陈莉综述金国祥审校长期以来，人们诊断肛管直肠疾病主要通过直肠指诊、肛管镜和放射学技术，这些方法只能发现肛管直肠隆起性病变或软组织肿瘤，无从显示肛管括约肌的结构与功能。近年来直肠动力学检查虽已广泛用于...     

经会阴部动态超声检查盆底的初步报告

目的 探讨经会阴部动态超声检查对评价静息及力排时盆底与肛管和直肠之间关系的可能性。方法 选择5例正常志愿者作为对照组，10例因大便习惯改变而就诊的患者作为异常组。所有患者取膀胱截石位，选用3．75～6MHz线凸阵探头进行检查。通过向肛门内注入超声耦合剂，让患者作排便动作，观察静息及力排时肛管直肠连接部的变化及耦合剂排出情况，并与临床手术及其他影像学检查进行对照。结果 正常组在力排时均能顺利排出造影剂；直肠前壁连续性好，肛管直肠连接部位置下移、肛直角增大或无变化；异常组显示直肠前突7例，耻直肌痉挛2例，直肠前壁黏膜脱垂1例。结论 经会阴部超声检查可以实时显示提肛肌水平以下的盆腔结构，通过观察静息及力排时肛管直肠的变化，可以显示排便时的生理过程，对于某些特异性的病变可以迅速作出诊断。     

非腺源性以感染为首发症状的肛管直肠及其周围疾病的超声诊断

目的 探讨超声对非腺源性以感染为首发症状的肛管直肠及其周围疾病的诊断价值.方法 对61例非腺源性以肛管直肠周围感染为首发症状患者的病灶高频超声声像图特点进行回顾性分析.结果 晚期直肠黏腺癌5例,术后异物残留2例,骶尾前间隙畸胎瘤16例,坏死性筋膜炎4例,骶后藏毛窦23例,化脓性汗腺炎6例,直肠尿道瘘2例,直肠阴道瘘3例.结论 超声检查对非腺源性以感染为首发症状的肛管直肠及其周围疾病的诊断有重要价值.     

内痔患者发生直肠癌漏诊九例

直肠癌是常见的下消化道恶性肿瘤,因其早期症状不明显,常以便血为首发症状,极易误诊和漏诊。近年来,我院有9例直肠下段癌漏诊,现报告如下。1临床资料1·1一般资料本组男7例,女2例;年龄46~67岁,平均52·3岁。均有内痔病史多年。1·2临床表现便血8例,连续便血或间断数月不等,每日1~3次,伴有直肠下坠及排便不净、里急后重等症状。1·3确诊经过5例以内痔或混合痔住院手术,术中发现距肛门缘6~7 cm处直肠占位病变,活检病理报告为直肠癌。3例行内痔术后仍便鲜血或暗红色血,来院复诊时发现直肠占位病变。1例排黏液便,偶带脓血,首次诊断为结肠炎、内…     

功能性出口梗阻型便秘的诊断

功能性出口梗阻型便秘是以出口梗阻为主要临床表现的顽固性便秘 ,包括直肠前突、直肠内套叠、耻骨直肠肌综合征、会阴下降等。目前 ,对该病的诊断已不仅仅是依靠体检和形态学的辅助检查 ,而是借助电子技术进行动力学检查 ,从而确诊并对疗效做出观察与评价[1] 。本文就近年来这些检查方法作一综述。1　肛管直肠压力测定通过生理压力测试仪检测肛管直肠内压力和肛管直肠间的生理反射 ,获得实际测量时有关肌肉的活动资料 ,以了解肛管直肠的功能状态。张连阳等[2 ] 对 36例直肠粘膜脱垂 (ＲＭＰ)和 2 5例直肠全层脱垂 (ＦＴＲＩ)患者进行测压 ,…     

排粪造影对出口梗阻性便秘诊断及术后疗效评价

目的:探讨排粪造影在出口梗阻性便秘的诊断与疗效评判中的价值。方法:对42例便秘患者行治疗前后排粪造影检查,并进行对比分析。结果:治疗前排粪造影诊断直肠前突+直肠黏膜内脱垂+盆底下降综合征12例,直肠前突+直肠黏膜内脱垂10例,直肠黏膜内脱垂+盆底下降综合征11例,直肠前突9例。治疗后6个月行排粪造影显示,37例正常,有效率88.1%。12个月后行排粪造影检查显示30例正常,有效率为71.4%。结论:排粪造影能更准确地诊断出口梗阻性便秘,鉴别功能性梗阻,直观地反映疗效,为临床提供可靠依据。     

PPH手术在肛肠科的应用体会

自2002年3月以来,我们应用吻合器痔上粘膜环切术(PPH)治疗重度痔、直肠前突22例,疗效满意。现报告如下。1资料与方法1.1临床资料本组男17例,女5例;23～65岁,平均44.7岁,其中Ⅲ～Ⅳ期环形内痔13例,Ⅲ～Ⅳ期以环形内痔为主混合痔9例,合并有直肠前突2例。术前评价患者手术耐受力,处理合并症;术前1d进温流质饮食,术前清洁灌肠。1.2手术步骤①硬膜外麻醉,患者取截石位或折刀位。②在痔脱垂较少且粘膜外翻较轻的3个点用3把组织钳固定撑开,使痔核及直肠下端粘膜轻度外翻,将透明环形筒状肛管扩张器插入肛管,取出内拴,将肛门镜缝扎器插入肛管扩张器…     

Prolonged rectal bleeding associated with hemorrhoids: the diagnostic contribution of colonoscopy

We studied 387 patients with prolonged rectal bleeding and hemorrhoids (grades 2 and 3) routinely examined by anoscopy, proctoscopy, single contrast barium enema, and hemoglobin measurements. Normal results were obtained in 86 patients above the age of 40. Total colonoscopy in these patients revealed one patient (1.2%) with cancer, 19 (22.1%) with colorectal polyps, and one (1.2%) with angiodysplasia. These findings indicate that in patients above age 40, a full investigation of the large bowel should be done in every case of prolonged rectal bleeding despite the presence of substantial hemorrhoids. Double contrast barium enema or colonoscopy must be used, rather than single contrast barium enema, which proved to be an inaccurate method of investigating prolonged rectal bleeding.     

Radiology in the current assessment of ulcerative colitis

Plain abdominal radiography in acute ulcerative colitis is essential to detect acute colonic complications, such as acute dilatation and free perforation. Sealed perforations may not be detected. Useful information can be gained as to the extent and severity of the mucosal lesions, but can be unreliable so that a contrast examination is required. The double contrast barium enema is more accurate than the single contrast study in revealing the early mucosal lesions of colitis. It is the examination of choice to show the extent and severity of disease, and is of considerable value in the differential diagnosis of colitis. In active colitis, the unprepared double contrast barium enema is recommended. The success of the examination relies on the absence of fecal residue adjacent to an active mucosa. The technique, uses, and limitations of this type of examination are described.In the long-term management of colitis, the role of radiology is to show the presence of extensive disease, which indicates an increased risk of malignancy. Lesions such as strictures or polyps may be found and are more likely to be benign than malignant, but confirmation often requires endoscopic biopsy. In the search for malignancy regular barium enema examination is not recommended, as this can only reveal an overt tumor, whereas premalignancy can be detected histologically from an endoscopic biopsy.     

Barium enema examination: sensitivity in detecting colonic polyps and carcinomas

We analyzed the sensitivity of the barium enema examination in 128 patients with 191 endoscopically proven colonic polyps and 12 carcinomas, relative to patient age, indications, and the type of examination used. Seventy-seven patients (60%) had rectal bleeding, and 51 (40%) patients with 87 lesions, including six carcinomas, did not. Overall roentgenographic sensitivity was 88%, with a 93% detection rate in patients less than 70 years old as compared to 76% for older patients. Sensitivity of single- and double-contrast barium enema examination was 82% and 91%, respectively. There were similar detection rates for lesions 1 cm or more in size (91% vs 95% for single- and double-contrast examinations, respectively), but double-contrast examination was slightly better at detecting smaller polyps (88%, vs 70% for single-contrast examination). Compared to colonoscopy, which has an average reported false-negative rate of 12% in detecting neoplasms, the barium enema is similarly reliable, less costly, and safer.     

自发性胆囊内瘘43例分析

目的：总结自发性胆囊内瘘的诊治经验。方法：对43例胆囊内瘘的病例进行回顾性病例分析。结果：43例中胆囊十二指肠瘘28例，胆囊结肠瘘8例，胆囊胆总管、肝总管瘘9例，胆囊胃瘘3例，其中同时有两处瘘7例。术前B超检查41例，9例提示胆囊积气；1例提示胆囊壁腹腔面消失，右下腹探得结石影。7例术前行腹部平片检查，4例提示小肠梗阻；6例见结石影；2例显示胆道积气。8例行CT检查，其中2例显示胆囊、胆管气体。3例行ERCP，其中1例见十二指肠有异常造影剂溢出。术前仅9例考虑到胆囊内瘘的诊断，其余均在术中发现。43例均行胆囊切除或部分切除，37例胆囊胃肠瘘行瘘口修补，其中5例因瘘口过大利用部分胆囊壁来修补；4例胆囊胆管瘘在取尽结石后，经瘘口置T管引流，瘘口较大者亦利用胆囊壁修补。术后1例因感染性休克死亡；1例有少量胆漏，经引流治愈，其余均恢复良好。结论：萎缩性胆囊炎、胆囊结石应警惕合并胆囊内瘘。出现以下情况提示胆囊内瘘：(1)B超、CT、腹部平片发现胆道积气。(2)CT、腹部平片提示肠梗阻。有下列情况可确诊胆囊内瘘：(1)B超发现胆囊腹腔面消失。(2)B超、CT、腹部平片提示原有明确的胆囊结石消失或在异位出现。(3)ERCP、PTC等发现非胆管开口有胆汁或造影剂溢出。(4)口服造影剂或钡剂灌肠见造影剂进入胆囊。治疗应修补瘘口，瘘口过大可利用部分胆囊壁来修补。     

Preoperative barium contrast enema in patients with inguinal hernia

Whether patients over age 40 should have a barium contrast enema (BCE) examination for possible identification of an unsuspected colon carcinoma before elective inguinal herniorrhaphy remains an unanswered question. We reviewed the medical records of all patients over age 40 who had inguinal herniorrhaphy at our institution between January 1980 and December 1984. Of 80 patients, 46 received a preoperative barium enema. One asymptomatic colon carcinoma (2.1%) was discovered. The reported incidence of asymptomatic colon cancer found by BCE in association with inguinal hernia ranges from 0 to 2.5%. We conclude that if there is a cause and effect relationship between asymptomatic colon cancer and inguinal hernia, the mechanism is as yet unknown.     

Amyloidosis of the colon presenting as ischemic colitis: A case report and review of the literature

Review of the English literature revealed 21 cases describing abnormalities on barium enema secondary to amyloidosis of the colon. These cases were categorized as to frequency of specific barium enema findings and distribution within the colon. The most common radiologic findings were luminal narrowing (11 of 21), loss of haustrations (10 of 21), thickened mucosal folds (8 of 21), mucosal nodularity (8 of 21), and ulceration (6 of 21). The most frequent locations of disease within the colon were the descending and rectosigmoid portions (13 of 21). We present a case of primary amyloidosis that demonstrates the findings of bowel wall thickening and luminal narrowing on doublecontrast barium enema and computed tomography (CT). Pathologic examination in our case, in addition to similar observations from the literature, suggests that at least a part of the radiologic changes of colonic amyloid can be attributed to bowel ischemia.     

Myxedema megacolon

The radiological findings on barium enema examination of 239 patients with thyroid deficiency (192 hypothyroid and 47 myxedematous) were reviewed. A new radiologic finding of transverse ridging superimposed on megacolon is described in myxedema and an explanation for this finding is postulated. The colonic findings associated with thyroid deficiency are presented.     

Colonoscopically detected colorectal cancer missed on barium enema

The radiographs and clinical records of 26 patients with colorectal cancer missed on barium enema, and subsequently detected at colonoscopy, were reviewed to determine the cause of radiological error. Twenty (77%) of the patients were female. In 24 of 26 patients, anemia and/or rectal bleeding was a presenting feature. Fourteen of the 26 (54%) missed cancers were in the sigmoid colon, 10 (38%) in the ascending colon or hepatic flexure, and two (8%) in the rectum. Tumor size ranged from 20–100 mm. Fifteen were polyps, and 11 annular cancers. Fourteen (54%) were Dukes C or D tumors. Twenty-eight barium enemas in 23 patients were available for review: 86% were double-contrast studies. In 18 (76%), the cancer could be seen in retrospect and, in over half, the tumor was obvious. The dominant perceptive error was due to missing the lesion in the barium pool. Other major errors were missing the lesion en face or in overlapping loops. As most cancers were missed because of observer perceptive error, by both experienced and inexperienced radiologists, the authors recommend double reporting of all barium enemas.     

Flexible sigmoidoscopy as a screening procedure for asymptomatic colorectal carcinoma in patients with inguinal hernia

In patients about to have hernia repair, preoperative screening studies for early colorectal cancer using the rigid proctosigmoidoscope and barium enema have previously shown minimal cost effectiveness and poor patient acceptance. Flexible sigmoidoscopy may be more acceptable to patients and of greater diagnostic value. Between October 1980 and December 1983, 100 consecutive asymptomatic male surgical patients were examined using the Olympus 60 flexible proctosigmoidoscope. All patients were admitted for elective hernia repair. Age ranged from 21 to 88 years (mean 59.7). All patients with stool positive for occult blood on admission were excluded from this study. In addition, patients with any gastrointestinal symptoms, history of colorectal disease, or family history of colorectal polyps or carcinoma were excluded. Examinations were done under direct supervision of an attending surgeon (W.W. or C.S.C.). Of the 22 patients who had one or more benign polyps, three had villous adenomas. Two additional patients had carcinoma. Results of examination were completely normal in 63, while 13 patients were found to have hemorrhoids or diverticular disease. There were no complications and the procedure was well tolerated by all patients.     

Water as contrast medium for computed tomography study of colonic wall lesions

A tap water enema combined with intravenous iodine contrast medium was used for computed tomographic (CT) study of the entire clean colon in 35 patients. Thirty of them showed a high suspicion of rectal, colon, or cecal pathology at either clinical examination, barium enema study, or endoscopy. The remaining five patients were examined for suspected local recurrence of carcinoma. This CT technique detected the wall abnormality in all but one case with two small adenomatous polyps. This procedure, which is simple, inexpensive, and has a good acceptance and tolerance, can accurately detect mural wall abnormalities.