CT仿真内窥镜临床应用体会

目的探讨CT仿真内窥镜临床应用价值。方法共完成各种体腔(气道、消化道、鼻、咽、喉及血管腔)CTVE60例，所有病例先行螺旋CT扫描，将源图像传至工作站，经特殊软件处理，模拟纤维内镜检查。部分病例有纤维内窥镜对照。结果30例气道CTVE均清晰显示至段及部分亚段支气管，其中20例肿瘤性病变显示了狭窄或阻断面处理情况，但对纤支镜下肿瘤周围粘膜侵犯及肿块表面细节均显示不良。20例消化道CTVE显示中晚期胃癌、结肠癌良好，但对1例小息肉及2例胃溃疡均漏诊。鼻咽及喉部7例中1例鼻咽癌显示咽隐窝肿块，2例喉癌示声门不对称，3例血管CTVE显示2例主动脉夹层瘤及内膜瓣，1例显示前交通动脉瘤颈、体情况。结论CTVE显示病变部位明确，观察病变组织全面，可部分替代纤维内窥镜检查。但其肿块表面“菜花”状改变及其粘膜下浸润显示均不良，容易漏诊胃肠道良性溃疡及小息肉，说明CTVE分辨率仍不够高。鼻、咽、喉CTVE显示解剖细节十分逼真，血管CTVE在诊断主动脉夹层内膜瓣及破口，动脉瘤颈、体腔的显示方面独辟蹊径，做好消化道CTVE前的准备十分重要，以免造成误诊和漏诊。

CT Virtual Endoscopy:A Research for CHnical Application

Objective To evaluate clinical applications of CT virtual endoscopy. Mathods 60 patients were examined with CTVE includes various body cavities such as air way , digestive tract, nose, pharynx,larynx and vessel. All cases were examined with spiral CT, then transfered the source images to work station dealt with special soft - ware package imitated the examination of fiberoptic endoscopy,some cases were compared with real fiberoptic endoscopy. Results In 30 cases of CT virtual bronchoscopy,all segmental and parts of sub - segmental bronchi were showed clearly, CTVE could reveal stenosis and bronchi occlusions in 20 patients with pulmonary carcinoma,but missed mucosal metastasis infitration and details in surface of mass showed with bronchiscopy. Digestive tract(n = 20) CTVE also well revealed mid and late carcinoma in stomach and colon (n = 8), but missed small polypus(n =1) and stomach ulcer(n = 2). In 7 cases of nasopharynx and larynx CTVE, carcinoma of nasopharynx(n =1) and carcinoma of larynx(n = 2) can clearly displayed. Vascular CTVE (n = 3) could display the details of aneurysm, such as the site of the entry tear,false lumen, neck and lumen of aneurysm. Conclusion CTVE plays an important role in the diagnosis of diseases body cavities.