新生儿先天性巨结肠的X线诊断

先天性巨结肠,又称肠管无神经节细胞症（或称Hirschsprtmg,HD病）,是新生儿常见的一种结肠先天性畸型,X线检查对本病确诊是不可缺少的直观的方法,早期诊断对指导临床的治疗及预后有重要的意义。本文收集了2002年2月-2008年6月在我科经X线检查确诊为先天性巨结肠的23例新生儿的X线资料,并结合临床进行分析和探讨如下。     

新生儿天性巨结肠的X线诊断

本文报告３０例经病理确诊的新生儿先天性巨结肠。对本病的临床及Ｘ线表现进行分析,重点讨论新生儿巨结肠Ｘ线钡灌肠检查方法及对特殊类型结肠的Ｘ线诊断予以探讨。     

先天性巨结肠类缘病的X线诊断——与先天性巨结肠对照分析

目的 探讨先天性巨结肠类缘病的X线表现特征.资料与方法 回顾分析经病理证实的14例巨结肠类缘病患者的钡剂灌肠X线表现,并与先天性巨结肠进行对照分析.结果 14例X线表现多样.9例直肠、乙状结肠或降结肠有痉挛狭窄,其中2例呈跳跃性狭窄,1例直肠及整个结肠细小,近段结肠有不同程度的扩张;13例未见移行段;24 h复查13例结肠内有大量钡剂残留;12例结肠有较多痉挛切迹;3例整个结肠张力高呈"腊肠样",不扩张或稍扩张.巨结肠类缘病的X线征象与巨结肠比较移行段、痉挛段肠管不规则收缩的P值＜0.05,24 h钡剂残留情况及痉挛狭窄段P值＞0.05.结论 钡剂灌肠有下列X线征象时应警惕有巨结肠类缘病:(1)痉挛段长且有较多痉挛切迹,痉挛段与扩张段之间没有移行段;(2)结肠张力高,形态僵直如"腊肠样";(3)"跳跃型"和"全结肠型"痉挛狭窄.     

婴幼儿先天性巨结肠的X线诊断

目的：探讨婴幼儿先天性巨结肠的X线诊断要点.方法：收集我院47例经手术及病理证实的先天性巨结肠患儿,分析其腹部立位片及结肠钡剂造影的影像学表现.结果：腹部立位片示低位结肠不全性梗阻35例,肠淤张17例,小肠低住梗阻1例.结肠钡剂造影显示常见型39例,短段型5例,超短段型2例,长段型1例,征象可见痉挛段、移行段及扩张段,其中3例新生儿及超短段型狭窄段显示不明显,3例移行段显示不明显,24 h复查38例有不同程度钡剂残留.结论：凡临床怀疑先天性巨结肠的婴幼儿应尽早行腹部立位片及结肠钡剂造影检查,并随访观察24 h钡剂排空情况,对其早期诊断及治疗有重要意义.     

小儿先天性巨结肠的X线诊断

目的 明确小儿先天性巨结肠的X线表现。方法 分析58例先天性巨结肠钡剂灌肠X线改变。结果 58例先天性巨结肠均表现为直肠末段不同范围痉挛性狭窄。结论 钡剂灌肠检查对小儿先天性巨结肠有确诊作用。     

先天性巨结肠的X线诊断

我院自1994年1月至2003年12月，累计巨结肠病儿22例，约占新生儿肠梗阻的21％。现总结报告如下：     

婴儿先天性巨结肠X线诊断

目的：探讨婴儿先天性巨结肠的Ｘ线特征及其检查方法。材料和方法：经手术及病理证实的１７例婴儿先天性巨结肠的Ｘ线表现与手术结果对照。结果：婴儿先天性巨结肠好发于直肠及乙状结肠的交界处。最典型的Ｘ线表现为狭窄、移行、扩张段并２４小时后均有不同程度的钡潴留。婴儿期先天性巨结肠的检查方法具有一定的特殊性。结论：Ｘ线检查是诊断婴儿先天性巨结肠的重要方法,绝大多数病例具有典型的表现。     

小儿先天性巨结肠不典型X线征群对诊断的意义

目的：探讨新生儿先天性巨结肠不典型X线征的诊断价值。方法：搜集经手术和病理证实的34例具有不典型X线征的先天性巨结肠新生儿．对他们的腹部平片和钡剂灌肠结果进行研究。结果：新生儿先天性巨结肠腹部平片多表现为结肠低位梗阻和肠淤胀(23例，占67．6％)，少部分表现为小肠低位梗阻(9例，占26．5％)。直肠下端局限性切迹(13例)，直肠和下段乙状结肠的螺旋形或不规则大锯齿状收缩(8例)，24h随访钡剂潴留(18例)．结肠炎表现(11例)．为钡剂灌肠不典型征群。结论：直肠下端局限性切迹和直肠下段乙状结肠的螺旋形或不规则大锯齿状收缩以及24h随访钡剂潴留、结肠炎表现征象对于新生儿不典型先天巨结肠的诊断价值较大。     

成人先天性巨结肠的X线诊断

目的：探讨成人先天性巨结肠症的临床及X线的关系。材料与方法：回顾性分析5例先天性巨结肠的临床及X线表现并进行对照。结果：全部病例均有慢性便秘症状，X线表现与小儿先天性巨结肠病相仿，惟前者结肠狭窄段较短。结论：钡灌肠检查是成人先天性巨结肠的主要临床确诊方法，成人慢性便秘应首选钡灌肠检查，如显示出结肠边缘光滑的狭窄段及近段肠腔相应扩张，可考虑成人先天性巨结肠。     

新生儿先天性巨结肠不典型X线征群的探讨

目的　探讨新生儿先天性巨结肠不典型X线征群的诊断价值。方法　搜集经手术和病理证实的 36例先天性巨结肠新生儿 ,设为病例组 ;对照组为同期亦经手术和病理证实的 37例非先天性巨结肠新生儿。对他们的腹部平片和钡剂灌肠结果进行对照研究。结果　新生儿先天性巨结肠腹部平片多表现为结肠低位梗阻和肠淤张 (2 3例 ,占 70 % ) ,少部分表现为小肠低位梗阻 (9例 ,占2 7% ) ,与对照组比较差异无显著性意义 (P >0 0 5 )。阴性表现者 1例 ,与对照组比较 ,差异具有显著性意义 (P <0 0 5 )。直肠下端局限性切迹 (13例 )、直肠和下段乙状结肠螺旋形或不规则大锯齿状收缩 (8例 )、2 4h随访钡剂潴留 (18例 )、结肠炎表现 (11例 )、结肠空肠化 (4例 )、钡粪相混征 (18例 )和胎儿型结肠 (6例 )为钡剂灌肠不典型征群。前 3者在病例组和对照组比较 ,差异具有非常显著性意义 (P <0 0 1) ;后 3者差异无显著性意义 (P >0 0 5 )。局限性切迹、直肠和下段乙状结肠螺旋形或不规则大锯齿状收缩、2 4h随访钡剂潴留 3个钡剂灌肠征象对新生儿先天性巨结肠的诊断敏感度分别为 38%、2 4 %、5 3% ;特异度分别为 95 %、10 0 %、78% ;正确指数 (Youden指数 )分别为 0 33、0 2 4、0 31。结论　直肠下端局限性切迹、直肠和下段乙     

新生儿肺出血的X线诊断

作者报告４０例经病理证实的新生儿肺出血Ｘ线表现。根据病变程度把肺出血分为三期：（１）早期；（２）演变期；（３）终末期。对胸部有无原发病的肺出血Ｘ线改变进行观察对比，提出两肺透亮度突发性、广泛性、均匀性降低是肺出血演变过程中极为重要的Ｘ线征象，并与出血肺泡的数目有关。重视Ｘ线、临床、病理相结合，配合短期Ｘ线随访观察，是一种可靠的诊断和研究方法，可提高本病的诊断率。还讨论了肺出血的鉴别诊断及Ｘ线检查的价值。     

侧方扩展型大肠肿瘤的X线特征

目的:探讨扩展型大肠肿瘤的X线与病理学特征。方法:分析了经组织病理学证实的46例54处病变的X线钡灌肠造影表现和内镜图像,将病变分为非结节扁平隆起、结节集簇性隆起和混合性结节集簇隆起3种类型,与病理组织学进行对照研究。结果:扩展型大肠肿瘤好发于直肠、盲肠和升结肠近段,组织病理学多为腺瘤或黏膜内癌,混合结节集簇隆起型病变癌变率高、浸润较深,且有进展期癌。结论:扩展型大肠肿瘤表面的形态改变,可以作为推测有无癌变与癌变浸润深度的指标。     

硫酸钡结肠灌肠检查的并发症(文献复习附4例报告)

作者报告4例钡剂或空气灌肠时发生的肠穿孔,并复习国外文献,讨论了钡灌时发生严重并发症的原因、病理和诊断,提出了避免和紧急处理的方法,认为放射科医师对此问题应予重视。     

新生儿胃食管返流影像学分析(附44例报告)

目的：分析新生儿胃食管返流的Ｘ线征象,评价Ｘ线诊断的价值。方法：患儿４４例,年龄均小于２８天,给予稀钡１０￣３０ｍｌ,在仰卧位检查,不用腹部加压。结果：钡剂进入胃囊后即发现钡剂由胃向食管返流,并见（１）食管胃角变钝（２）食管前庭部增宽（３）食管扩张、弛缓。于５ｍｉｎ内见３次以上返流。结论：钡餐造影是新生儿食管检查最简单,安全、有效的方法。恰当的造影技术颇为重要。     

Barium enema "shoulder" sign: a useful predictor of pericolonic fat invasion in colorectal cancer

PURPOSE: We aimed to determine the presence of the "shoulder" sign in prediction of pericolonic fat invasion on double-contrast barium enema (DCBE) studies in colorectal cancer. MATERIALS AND METHODS: Patients at our institution with apparent colorectal cancer were identified from a computer search of both radiological and surgical pathology records during a recent 30-month period. The presence of a shoulder sign was defined as a tumor margin having an abrupt transition from the intraluminal component to the adjacent normal mucosa, forming a shouldered edge on barium studies. RESULTS: A total of 49 patients (53 lesions) for whom the DCBE studies and surgical pathology records were available for review were proven to have colorectal carcinomas. DCBE studies revealed that 45 patients with lesions (85%) presented with a "shoulder" sign. All of these lesions were correctly diagnosed as colorectal cancer. Of these, 89% had pericolonic fat invasion and 44% had regional lymph node metastases. Of lesions without a shoulder sign, 25% had pericolonic fat invasion and 25% had nodal metastases. CONCLUSION: The presence of shoulder sign detected with barium enema can be a useful predictor of pericolonic fat invasion in colorectal cancer.     

Complications from radiographer-performed double contrast barium enemas

AIM: To determine the types and rates of complications encountered by radiographers when performing double contrast barium enemas (DCBE). MATERIALS AND METHODS: Seven hundred and forty-one questionnaires were posted to radiographers who had in the last 5 years attended one of the biannual barium enema training courses. RESULTS: Of 741 questionnaires posted 407 (54.9%) were returned completed. Approximately 348,000 barium enema examinations had been performed. Fifty-nine radiographers reported 89 complications, including 13 intra-peritoneal and 11 extra-peritoneal perforations. There were five deaths (mortality 1 in 70,000). Deaths resulted from two of 24 (10%) perforations, two of 45 (5%) cardiac events and one cerebrovascular accident that occurred during an examination. CONCLUSIONS: Radiographers have been regularly performing DCBEs for almost a decade. The mortality for radiographer-performed DCBE is similar to that previously reported for radiologists, although a slightly higher rate of perforation is noted and so this is an area where radiographer training should be targeted.     

钡灌肠对结肠癌的X线诊断价值(附8例对照分析)

目的 钡灌肠是诊断大肠病变的最基本检查方法，结合文献复习探讨钡灌肠X线检查结肠癌的价值。方法 对8例钡灌肠患者进行回顾性分析，观察X线诊断大肠癌的可靠征象，分析钡灌肠的优势及局限性。结果 钡灌肠8例，结肠癌3例并与CT诊断、电子肠镜检查、手术所见对照。结论 钡灌肠对诊断大肠病变有其重要的价值。     

Small-bowel motility disturbances: A comparison of small-bowel series and antroduodenal manometry

RATIONALE AND OBJECTIVES: The authors' purpose was to compare the findings of small-bowel series with those of antroduodenal manometry to determine whether normal findings from a small-bowel series would make it unnecessary to perform antroduodenal manometry. MATERIALS AND METHODS: The findings from 33 small-bowel series performed on patients who had undergone antroduodenal manometry were retrospectively reviewed for abnormalities, including dilatation, transit time, fold thickening, and increased fluid. Antroduodenal manometry findings were classified into the following categories: normal, myopathy, neuropathy, obstructions, or nonspecific conditions. RESULTS: Nine of 12 patients with specific abnormalities at antroduodenal manometry had abnormal results from the small-bowel series. Of seven patients with normal small-bowel series results, three had abnormal antroduodenal manometry results--two had previously undergone vagotomy with neuropathic changes and one had myopathic changes. CONCLUSION: Small-bowel series and antroduodenal manometry are complementary examinations. Only a small number of patients with normal small-bowel series results will have abnormal results at antroduodenal manometry. A large number of patients with motility abnormalities have a combination of nonspecific changes, such as dilatation and increased fluid, at a small-bowel series.     

钡灌肠双重造影诊断阑尾炎的应用分析

目的 分析钡灌肠双重造影对诊断阑尾炎的可行性.方法 对临床疑有阑尾炎的75例病人,采用造影前2 d流食,造影当日清洁肠道,用足量的钡剂快速注满右半结肠,辅以体位和加压促使阑尾显影.结果 75例中,阑尾炎X线征象典型者41例,21例阑尾部分显影,13例未显影.41例手术病人中X线确诊病例25例,占61.1%,阑尾部分显影X线提示可疑阑尾炎10例,占24.3%,6例X线不显影,未能做出X线诊断,占14.6%.结论 临床怀疑有阑尾炎的病人,可选择钡灌肠双重造影,其检查方法简单、安全且具有较高的诊断准确性.