泛影葡胺造影在诊断上消化道穿孔中的应用

目的：探讨泛影葡胺造影对上消化道穿孔者的诊断价值。方法：对临床上怀疑上消化道穿孔的112例患者，术前使用泛影葡胺造影，并对该组的临床资料进行回顾性分析。患者在透视下动态观察有无造影剂经胃、十二指肠漏出并摄片分析，有造影剂漏出为阳性，无则为阴性。结果：112例患者行泛影葡胺造影，阳性者72 例：胃穿孔31 例，其中胃溃疡穿孔27例，胃癌穿孔4例；十二指肠球部穿孔 41例。阴性者40例，其中39例经CT、急诊胃镜检查及剖腹探查确诊为其他疾病，但有1例阴性者行剖腹探查诊断为胃后壁穿孔。该法的诊断符合率99.1 %，敏感性98.6%，特异性100%，全组假阴性1例，无假阳性。结论：泛影葡胺在诊断上消化道穿孔中安全、有效、方便、价廉，有其重要应用价值。

Application of gastrografin contrast in diagnosis of upper gastrointestinal tract perforation

Objective: To assess the value of gastrografin (meglumine diatrizoate) contrast in diagnosis of upper gastrointestinal (GI) tract perforation. Methods: The clinical data of 112 patients with clinically suspected upper GI tract perforation who underwent gastrografin contrast examination were retrospectively analyzed. The patients were dynamically observed by fluoroscopy to determine whether there was leakage of the contrast agent from the stomach or duodenum and x-ray films were taken for analysis. The result was positive for upper GI tract perforation if contrast agent leakage was present and vice versa. Results: All the 112 patients underwent gastrografin contrast examination, of whom 72 cases had positive findings that included 31 cases of stomach perforation (27 cases of perforated gastric ulcer and 4 cases of perforated gastric cancer) and 41 cases of duodenal bulb perforation due to peptic ulcer. Of the remaining 40 patients with negative finding, 39 cases were identified to have other diseases by CT, emergency gastroscopy examination or exploratory laparotomy, but one case was found to be perforation of the posterior gastric wall on exploratory laparotomy. The coincidence rate of gastrografin contrast examination in diagnosis of upper GI tract perforation was 99.1%, and the sensitivity and specificity rate was 98.6% and 100%, respectively. No false positive case was found but there was one false negative case in the whole group. Conclusion: Gastrografin contrast has important application value in diagnosis of upper GI tract perforation, as it is safe, effective, and of relatively low cost.