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1、肠道病变的钡剂检查上海交通大学医学院附属瑞金医院放射科陈克敏Dept. of RadiologyRuijin Hospital小肠造影的方法小肠造影的方法口服法、插管法、逆行法；插管法又分为甲基纤维素法、气钡法和稀钡法；小肠的正常X X 线表现。Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital结肠的钡剂检查结肠的钡剂检查良好的肠道准备是结肠钡剂检查成功的重要条件。肠道准备采用限制饮
2、食，给予泻药和多量饮水的准备方法。Dept. of RadiologyRuijin Hospital结肠双对比造影结肠双对比造影钡剂浓度：70%80%W/V70%80%W/V钡剂注入量：200ml200ml左右气体注入量：1000ml1000ml左右采用变动体位，分段摄片，再摄取全结肠片Dept. of RadiologyRuijin Hospital结肠的正常结肠的正常X X线表现线表现结肠袋和结肠粘膜纹结肠的生理性收缩直肠、乙结肠交界处、乙降结肠交界处、降结肠下段、脾曲下段、横结肠段、升结肠近段、盲升结肠的交界段结肠的粘膜细节无名沟和无名小区Dept. of RadiologyRuijin
3、 HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital结肠双对比造影常见的伪影结肠双对比造影常见的伪影粪便和食物残渣气泡伪影钡剂的凝聚、龟裂粘液流动伪影肠曲和骨结构的重叠影D
4、ept. of RadiologyRuijin Hospital小小 肠肠 病病 变变Dept. of RadiologyRuijin Hospital回肠麦克尔憩室回肠麦克尔憩室Dept. of RadiologyRuijin Hospital小肠息肉样病变小肠息肉样病变主要是腺瘤和其它息肉样上皮增生等单发或多发呈类圆形的小充盈缺损和环圈征通常肠曲形态柔软、扩张良好Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital小肠腺癌小肠腺癌常有明显的粘膜破坏征象肠曲呈不规则的狭窄不规则的充盈缺损肿块边缘呈结节状和指压迹表
5、现Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital小肠平滑肌瘤和平滑肌肉瘤小肠平滑肌瘤和平滑肌肉瘤病人常有较明显的消化道出血症状呈类圆形的充盈缺损肿瘤累及肠段，可见粘膜展平CTCT检查可见软组织肿块和肠壁增厚血管造影检查可见明显的肿瘤染色Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. o
6、f RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital小肠的炎症性病变小肠的炎症性病变非特异性炎症放射性肠炎缺血性肠炎感染性肠炎Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital克隆病（克隆病（CrohnCrohns s diseasedisease）粘膜皱襞变粗、变平、紊乱卵石状或息肉样充盈缺损表现溃疡及锯齿状表现肠管狭窄脓肿和瘘管好发于末端回肠，并可发生于空肠、盲肠、结肠及其它消化
7、道管腔Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital小肠淋巴瘤小肠淋巴瘤发生于肠壁粘膜下层中的淋巴组织。 肠管变形、狭窄或增宽 粘膜纹紊乱、增粗，呈脑回状 溃疡及巨大溃疡 小肠的功能改变Dept. of RadiologyRuijin Hospital小肠转移性肿瘤小肠转移性肿瘤可由原发肿瘤直接侵犯、腹腔种植或瘤栓转移而来。原发肿瘤中以黑色素瘤、乳癌、肺癌、肾癌、卵巢癌、子宫癌、前列腺癌等多见。Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin
8、Hospital小肠类癌小肠类癌 常好发于回肠末端和阑尾 肿瘤可多发，体积通常不大 呈类圆形或小息肉样表现Dept. of RadiologyRuijin Hospital结结 肠肠 病病 变变溃疡性结肠炎溃疡性结肠炎早早早早 期：期：期：期：粘膜纹及粘膜细节水肿、紊乱，继而出粘膜纹及粘膜细节水肿、紊乱，继而出现细小颗粒状改变。现细小颗粒状改变。进展期：进展期：进展期：进展期：溃疡形成，呈揿扣状，可在粘膜下贯通。溃疡形成，呈揿扣状，可在粘膜下贯通。溃疡形成，呈揿扣状，可在粘膜下贯通。溃疡形成，呈揿扣状，可在粘膜下贯通。假性息肉及粘膜桥。假性息肉及粘膜桥。假性息肉及粘膜桥。假性息肉及粘膜桥。晚晚
9、晚晚 期：期：期：期：肠管变僵、缩短、狭窄。肠管变僵、缩短、狭窄。Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital结肠克隆病结肠克隆病 多发生于右侧结肠，也以回盲部好发，但可发生在结肠任何部位。 粘膜水肿、粗糙 口疮样溃疡 窦道和瘘管 肠腔变窄，肠袋消
10、失Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital结结 核核 结肠结核好发于回盲部，可累及升结肠肝曲及多段累及，但左侧结肠累及较少。 溃疡性结肠结核 增殖性结肠结核Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital子宫内膜异位症子宫内膜
11、异位症Dept. of RadiologyRuijin Hospital结肠息肉结肠息肉息肉良恶性的鉴别：息肉良恶性的鉴别：大小、边缘、蒂、基底部，大小、边缘、蒂、基底部，大小是主要的判别标准之一。大小是主要的判别标准之一。 单发息肉 多发息肉 息肉病 带蒂息肉 无蒂息肉 广基息肉 狭基息肉Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital结肠癌结肠癌隆起型溃疡型浸润型Dept. o
12、f RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital结肠转移癌结肠转移癌多见于邻近肿瘤的直接侵犯和种植性转移Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital多发结肠癌多发结肠癌发生机率约为10%15%10%15%，可为同时癌或异时癌，结肠多发息肉和结肠息肉病患者其发生结肠癌的危险性要明显高于正常人群。Dept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin HospitalDept. of RadiologyRuijin Hospital
