经腹超声诊断胃静脉曲张

目的 探索经腹二维超声结合彩色多普勒血流显像（CDFI）和脉冲多普勒（PD）诊断胃静脉曲线（GV）的实用价值。方法 对155例肝硬化患者进行胃二维超声造影检查,发现疑有GV者再行CDFI和PD检查。GV按国内传统的食管静脉曲张分级标准分级,检查结果经胃镜等方法比较。结果 经腹超声诊断GV20例,与其他方法比较,超漏诊3例,为轻度GV。GV的经腹超声率为87％（20／23）。结论 经腹超声诊断GV对于患者疾病严重程度的判断、严重并发症的防范、治疗方案的以及疗效的观察都具有一定的实用意义。对肝硬化伴门静脉高压患者应常规作胃超声检查。     

胃癌及各型慢性胃炎的经腹胃B超诊断价值

虽然胃镜、超声内镜及经内镜微超声探头（TEMP）在各种胃病诊断中起着至关重要的作用，但对为数不少的不愿意接受器械检查的患者，经服腹胃B超还是常用的检查方法。为此，我们将经腹胃B超与胃镜、病理结果对照，观察其对各种胃病的诊断价值。     

经腹超声诊断胃常见疾病及评估胃排空功能的应用体会

超声检查时借助口服超声助显剂可使胃壁及其病变清晰显示。本文就我科在经腹超声诊断胃常见疾病和胃排空功能评估方面的应用体会进行分享,希望经腹胃超声检查方式能更普及,使更多患者受益。     

胃窗超声造影剂临床应用体会

超声对实质性脏器的检查已被临床医生首选,但胃、十二指肠由于气体等因素的干扰,一般经腹超声检查不能清楚显示胃、十二指肠的层次结构。而应用胃窗超声造影剂使胃、十二指肠充分充盈,可清楚显示其壁厚、层次结构、黏膜面改变及腔外情况。     

经腹胃充盈超声造影诊断功能性消化不良患者胃动力障碍的价值探讨

目的探讨经腹胃充盈超声造影对功能性消化不良(FD)患者胃动力障碍的诊断价值。方法应用经腹胃充盈超声造影分别检查FD患者150例(FD组)和健康志愿者50例(对照组),应用三维超声计算机辅助虚拟器官分析技术测量胃体、胃窦容积,二维超声测量胃窦蠕动波幅度、速度、频率等,并计算胃窦收缩分数和胃窦动力指数,比较两组上述测量参数的差异。绘制受试者工作特征(ROC)曲线获得差异有统计学意义的各参数诊断FD的截断值,并以临床诊断结果为标准计算其诊断效能。结果FD组的年龄、胃体体积、胃窦体积、胃壁蠕动频率、胃窦蠕动波速度与对照组比较,差异均无统计学意义;两组胃窦蠕动波幅度、胃窦收缩分数、胃窦动力指数比较,差异均有统计学意义(均P<0.05)。ROC曲线获得胃窦蠕动波幅度、胃窦收缩分数、胃窦动力指数的诊断FD的截断值分别为8.5 mm、55.5%、24.9 mm^2/s,曲线下面积分别为0.780、0.776、0.778,诊断敏感性分别为78.67%、69.33%、77.33%,特异性分别为78.00%、78.00%、80.00%,诊断符合率分别为78.50%、71.50%、78.00%;三项指标联合诊断的敏感性、特异性、诊断符合率分别为81.33%、78.00%、80.50%。结论经腹胃充盈超声造影对FD患者的胃动力障碍具有一定的诊断价值。     

经腹胃充盈超声造影对功能性消化不良患者胃动力障碍的诊断价值

目的 探讨经腹胃充盈超声造影对功能性消化不良患者胃动力障碍的诊断价值。方法 应用经腹胃充盈超声造影分别检查功能性消化不良患者150例（功能性消化不良组）和健康志愿者50例（对照组）,应用三维超声计算机辅助虚拟器官分析（virtual organ computer-aided analysis,VOCAL)技术测量胃体、胃窦容积,二维超声测量胃窦部胃壁蠕动波幅度、速度、频率等,并计算胃窦收缩分数和胃窦动力指数,比较两组上述测量参数的差异。绘制受试者工作特征（ROC）曲线获得胃窦蠕动波幅度、胃窦收缩分数、胃窦动力指数诊断功能性消化不良的界值,并计算其诊断效能。结果 功能性消化不良组的年龄、胃体体积、胃窦体积、胃壁蠕动频率、胃窦蠕动波速度与对照组比较,差异均无统计学意义;胃窦蠕动波幅度、胃窦收缩分数、胃窦动力指数在两组间比较,差异均有统计学意义（均P＜0.05）。ROC曲线获得胃窦蠕动波幅度、胃窦收缩分数、胃窦动力指数的诊断界值分别为8.5 mm、55.5%、24.9 mm2/s,曲线下面积分别为79.97%、77.63%、77.84%, 诊断敏感性分别为78.67%、69.33%、77.33%,特异性分别为78.00%、78.00%、80.00%,诊断符合率分别为78.50%、71.50%、78.00%,三项指标联合诊断的敏感性、特异性、诊断符合率分别为81.33%、78.00%、80.50%。结论 经腹胃充盈超声造影对功能性消化不良患者的胃动力障碍具有一定的诊断价值。     

经腹B超对胃疾病诊断价值的探讨

目的探讨经腹B超对胃疾病的诊断价值。方法对96例曾行胃镜和／或胃肠双重对比检查后诊断胃有不同疾病后再行经腹B超检查。观察不同胃疾病经腹B超检查显示病变情况。结果96例不同胃疾病经腹B超检查病变显示81例，显示率为84．4％。结论经腹B超检查对不同胃疾病诊断、手术方案选择、判断预后均有较高价值。     

胃肿瘤急诊B型超声检查

本文报告了因呕血、腹痛、腹块、衰竭急诊胃肿瘤患者31例,B 型超声诊断检出率97%。并就胃肿瘤超声的特点、分区、分型及与手术的关系进行了探讨。这是一种最简便无创性检查方法,任何病人都可以接受。提出了急诊超声检查诊断重症胃肿瘤患者的可行性。     

管型吻合器在经腹全胃切除P型空肠袢代胃术中的应用

目的：探讨管型吻合器在经腹全胃切除P型空肠袢代胃术中的应用。方法：对126例经腹全胃切除P型空肠袢代胃术患者术中采用管型吻合器行食管-空肠、空肠-空肠（P型袢）及空肠-空肠（Roux-Y）吻合口吻合。结果：所有患者手术均获成功，手术时间2～2．5h，平均3．5h，其中3个吻合口吻合完成时间25～50min，平均40min；无手术死亡病例，无吻合口瘘、出血及狭窄等严重并发症。结论：经腹全胃切除P形空肠袢代胃术中采用管型吻合器行3个吻合口吻合具有操作简便、技术可靠及并发症少等优点。     

超声胃十二指肠水窗法对壶腹癌分型诊断的价值

目的探讨超声胃十二指肠水窗法对壶腹癌分型诊断的价值。方法34例壶腹癌患者行饮水前后超声准确率比较,并根据壶腹癌的不同超声表现分为壶腹内型、壶腹周型与混合型。结果饮水后壶腹癌的超声准确率为94.12%(32/34),明显高于饮水前的67.65%(23/34)。胃十二指肠水窗法将壶腹癌分型的阳性率由饮水前的26.47%明显提高到79.41%。结论胃十二指肠水窗法超声检查与常规超声检查比较,可明显提高壶腹癌诊断准确率,且可提示壶腹癌的分型,对临床制定恰当的治疗方案及评价预后具有重要的价值。     

Evaluation of Gastric Emptying by Transabdominal Ultrasound after Oral Administration of Semisolid Cellulose-Based Gastric Ultrasound Contrast Agents

Many previous studies have found that transabdominal ultrasound may allow precise measurement of gastric emptying of liquid meals. However, the clinical use of this technique has been hampered by the limitation that transabdominal ultrasound might not accurately measure gastric emptying of solid meals. It is more important to measure gastric emptying of solids instead of liquids, as gastric emptying of solids is more often delayed than gastric emptying of liquids in gastric motility disorders. Recently, transabdominal ultrasound after oral administration of a cellulose-based gastric contrast agents (TUS-OSCA) has been suggested to be effective in initial screening of gastric lesions. The aim of this study was to explore the accuracy of TUS-OSCA in the evaluation of gastric emptying of a semisolid meal. Twenty healthy young patients (10 males and 10 females aged 25.5?±?2.5 y) were studied. Concurrent measurements of gastric emptying by scintigraphy and TUS-OSCA were performed after ingestion of 350?mL semisolid ultrasound agent labeled with 20 MBq ^99mTc-sulfur colloid. There was no significant difference in the overall curves for gastric emptying time between scintigraphy and TUS-OSCA. There was a good correlation between the gastric 50% emptying times determined by scintigraphy (89.4?±?1.8?min) and TUS-OSCA (92.5?±?1.7?min). The correlation coefficient was r?=?0.922 (p?=?0.000). Current results indicate that TUS-OSCA is accurate, and the results are similar to those obtained by scintigraphy for gastric emptying of a semisolid meal.     

Transabdominal ultrasound for visualizing gastric submucosal tumors diagnosed by endosonography: can surveillance be simplified?

BACKGROUND AND STUDY AIMS: Management options for gastric submucosal tumors (SMTs) include tumor removal or surveillance. If the latter is chosen, it requires repeated measurements of the tumor diameter. Although this can be achieved using endoscopy or endosonography (EUS), a less invasive and cheaper method would be welcome. The aim of this prospective study was to assess the proportion of gastric SMTs that can be visualized using transabdominal ultrasound of the water-filled stomach. PATIENTS AND METHODS: Fifty-one consecutive patients with endosonographically diagnosed gastric SMTs underwent transabdominal ultrasound examinations of the water-filled stomach performed immediately after EUS; both procedures were carried out by the same investigator. Transabdominal ultrasound was considered positive only if: firstly, the tumor was visualized unequivocally; secondly, its dimensions could be measured; and thirdly, photographic documentation could be recorded. In each case, a positive result had to be confirmed by an independent investigator, who reviewed the photographic documentation. RESULTS: The median size of SMTs on EUS was 25 mm (range 4 - 55 mm). Twelve tumors were located in the antrum, 25 in the gastric body, and 14 in the gastric fundus or cardia. Transabdominal ultrasound demonstrated the tumor in 35 of 51 patients (69 %). For tumors < or = 30 mm, the visualization rate was 61 % (22 of 36). The location of the tumor and its EUS features did not significantly affect the sensitivity of transabdominal ultrasound. CONCLUSIONS: In 69 % of patients with endosonographically diagnosed gastric SMTs, the tumor can also be visualized (and measured) using transabdominal ultrasound of the water-filled stomach. This noninvasive and inexpensive method may potentially be useful for surveillance in patients with SMTs, and further evaluation in this setting is warranted.     

经腹超声对进展期胃癌的术前评价

目的评价经腹超声在进展期胃癌术前诊断和分型中的作用.方法对54例进展期胃癌患者进行了纤维胃镜和经腹超声检查,所有患者均经手术治疗并将上述检查结果与术后病理结果对照.结果经腹超声判断进展期胃癌的分型与病理结果一致性较好,Kappa值为 0.74,经腹超声分型准确率为 79.63%.经腹超声对胃周围肿大淋巴结总显示率为 64.1%,转移淋巴结显示率为 79.2%.结论经腹超声对进展期胃癌术前的诊断和分型有较高的准确性,在临床上有一定实用价值.     

Transabdominal US staging of gastric cancer

Penetration of gastric cancer through the wall is important because the treatment modality and prognosis are accordingly different. A prospective study was performed to assess the value of transabdominal ultrasonography in the differentiation of early gastric cancer limited within the mucosa and submucosa from advanced cancer extending into the muscle layer. Fifteen patients with early gastric cancer and 29 patients with advanced gastric cancer were evaluated preoperatively and compared with histological findings. Patients were referred after endoscopy and sonologists were informed of the site of the gastric lesions. Patients ingested 600–800 ml of boiled water and transabdominal ultrasonography of the gastric lesion was accomplished using a commercially available ultrasound equipment with 5.0 and 3.5 MHz transducers. Using the intact middle hyperechoic layer on sonogram as the criterion for early cancer, 10 of 15 patients with early gastric cancer and 27 of 29 patients with advanced gastric cancer were correctly diagnosed (84%). Fourteen of 15 cases with early gastric cancer showed a thickness of the lesion below 1.0 cm, while seven of 29 cases with advanced cancer showed a thickness 1.0 cm or less. We believe that transabdominal sonography may be a valuable method in the differentiation between early and advanced gastric cancer.An editorial commentary on this article follows on pp. 532–536.     

脾切除术胃底损伤的原因及处理

目的：探讨因各种原因的脾切除术引起胃底区胃壁组织损伤的原因、处理方法及预防措施。方法：回顾分析12年来17例胃底损伤的临床资料，对损伤的原因、诊断、处理方法和预防措施进行分析总结。结果：17例胃底损伤中，贲门周围血管离断术＋脾切除11例，单纯脾切除6例。术中发现13例并给予及时处理，术后全部痊愈。4例因术后化脓性腹膜炎再手术发同胃底部坏死穿孔，行手术修补、腹腔引流术，3例死亡（75％），1例痊愈（25％）。结论：清楚的解剖、规范的操作是预防胃底部胃壁组织损伤的关键，及时发现和正确处理对争取良好的预后十分重要。     

Ultrasound of the stomach--the EUROSON lecture 2006

The stomach is a fascinating organ. It has the capacity to expand its volume substantially to receive and accommodate food after a meal, normally without any conscious notice of the expansion. The aim of this paper is to show how transabdominal ultrasonography can disclose the structural and functional abnormalities of the stomach. Ultrasound of the stomach was initially performed to detect and investigate organic diseases of the gastric wall. Subsequently, different methods were developed to study functional aspects of gastric pathology. Ultrasound can be used to evaluate antral contractility, gastric emptying, transpyloric flow, gastric configuration, intragastric distribution of meals, gastric accommodation and strain measurement of the gastric wall. Advanced methods for 3D ultrasound imaging and tissue Doppler (Strain Rate Imaging) have also been developed to study diseases of the stomach. The Ultrasound Meal Accommodation Test (U-MAT) can be applied to characterise patients with organic and non-organic dyspepsia. Ultrasonography still has a great potential as a clinical method, and some day our patients may receive both diagnosis and treatment in the same session.     

Prospective Comparison of Oral Contrast-Enhanced Transabdominal Ultrasound Imaging With Contrast-Enhanced Computed Tomography in Pre-operative Tumor Staging of Gastric Cancer

The aim of this prospective study was to compare the diagnostic accuracy of oral contrast-enhanced transabdominal ultrasound imaging (OCTU) with that of contrast-enhanced computed tomography (CT) for the pre-operative tumor staging of gastric cancer, with post-operative pathology as the standard. We included 108 cases of gastric cancer with simultaneous OCTU and enhanced CT pre-operative tumor staging diagnoses. Results were compared with post-operative pathology based on the eighth edition of the American Joint Committee on Cancer tumor–node–metastasis staging guidelines for gastric cancer. The accuracy of each tumor stage was obtained by comparing OCTU and enhanced CT diagnoses with post-operative pathology. The McNemar test was used to compare the overall accuracy of the two methods. There was no statistical difference in accuracy between OCTU (72.2%) and enhanced CT (75.9%, p = 0.644) for overall pre-operative tumor staging diagnosis. For stages T1 to T4, the accuracy rates of OCTU were 84.2%, 81.8%, 69.4% and 65.5%, respectively, and those for enhanced CT were 52.6%, 72.7%, 87.8% and 72.4%, respectively. OCTU is comparable to enhanced CT in the preoperative overall T-stage diagnosis of gastric cancer.     

Evaluation of Transabdominal Ultrasound with Oral Cellulose-Based Contrast Agent in the Detection and Surveillance of Gastric Ulcer

The aim of this study was to assess the role of transabdominal ultrasound with cellulose-based oral contrast agent (TUS-OCCA) in the detection and surveillance of gastric ulcer. The study was approved by the institutional review board at Shengjing Hospital of China Medical University. A total of 124 consecutive patients with benign gastric ulcer diagnosed by gastroscopy and biopsy were enrolled. Serial TUS-OCCA (approximately 1 exam every 2 wk) was performed to monitor the effects of treatment, and additional interventions were planned according to the results. TUS-OCCA detected gastric ulcer in 76% of patients (94 of 124). The detection rates for lesions of ≤5 mm, lesions of 5–10 mm, lesions of 10–15 mm and lesions >15 mm were 32% (10 of 31), 77% (27 of 35), 96% (25 of 26) and 100% (32 of 32), respectively. The detection rates for lesions located in the antrum, angle and body were 70%, 84% and 85%, respectively. Among 30 undetected lesions, which ranged 2–13 mm in size, 11 were at the antrum, 9 at the angle, 3 in the body, 6 at the cardia and 1 at the fundus. During the follow-up period, patients underwent a mean of 3.8 TUS-OCCA examinations (range 2–7), and ulcers were healed after 8 wk (range 2–12 wk) of standard therapy in 76 patients. Eighteen patients who did not show improvement after standard therapy underwent repeat gastroscopy with biopsy. Repeat biopsy was positive for gastric cancer in 4 of these: 2 of the remaining 14 were diagnosed with gastric cancer at gastrectomy, and 12 were diagnosed with chronic benign ulcer. These results indicate that serial TUS-OCCA can be used for close monitoring during routine treatment of gastric ulcers that are detectable by TUS-OCCA and that monitoring by TUS-OCCA can guide additional interventions. A non-invasive follow-up program based on TUS-OCCA can also help to detect gastric cancers that have been misdiagnosed as benign ulcers at the initial endoscopic biopsy.     

Gastric fundus impression caused by splenic vessels: detection by endoscopic ultrasound

When a submucosal impression of the stomach fundus is seen during upper GI endoscopy, a true submucosal tumor can reliably be differentiated from an extragastric impression by endoscopic ultrasound (EUS). We report on 15 patients in whom EUS identified splenic vessels near the splenic hilum causing an impression of the posterior wall of the gastric fundus. Neither by EUS nor conventional ultrasound, computed tomography or clinical follow-up, was a tumor in the stomach or upper abdomen that could have been the cause of the gastric wall impression, identified. Two of the 15 patients had portal hypertension with multiple intra-/paramural venous collateral vessels. Twenty patients examined for other reasons and 10 patients with portal hypertension but without fundic impressions, served as controls: In these cases the splenic vessels were shown by EUS to follow a course more distant to the gastric wall. Thus, normal vascular structures should be included in the differential diagnosis of gastric fundus impression detected by endoscopy.