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排粪造影于1953年由Wallden等[1]首次报道,近年来随着人们对肛肠疾病的关注,其逐渐成为国内外学者研究的热点。直肠黏膜脱垂作为一种常见疾病,也是导致出口梗阻型便秘的重要原因之一。国外学者根据直肠黏膜脱垂的范围和是否累及肠壁,将直肠黏膜脱垂分为黏膜脱垂、肠套叠和脱肛[2]。黏膜脱垂是指直肠黏膜脱入肛管,但是肠壁不受累;肠套叠类似小肠套叠,是指黏膜脱垂累及肠壁,形成了类似小肠套叠的影像;脱肛是指直肠黏膜脱出肛门外。就直肠黏膜脱垂而言,Shorvon等[3]将其分为7级;国内卢任华[4]将其分为3级,分别为直肠前壁黏膜脱垂、直肠内套叠和直肠外脱垂,何宪国等[5]的分级与其相似。然而,张胜本等[6]研究认为,排粪造影不能准确区分直肠套叠是否累及全层肠壁,可能影响直肠黏膜脱垂的分级。国内外学者均有将CT及MRI技术引入排粪造影的报道,虽然CT与MRI能够很好的显示直肠周围组织,但是不能动态观察,而且需患者良好的配合。由于检查价格昂贵,且患者也不便真正行排便动作而未能得以推广应用,使得传统X线排粪造影仍然是一种经济、有效的检查。为了给临床诊断和治疗提供更为准确的X线影像学指导,本研究收集整理了本院2012年6月至2014年3月共38例诊断为直肠黏膜脱垂病例的X线影像资料,依据直肠黏膜脱垂的解剖部位以及临床治疗方法的差异,对直肠黏膜脱垂进行细化分级,现报道如下。
直肠黏膜脱垂患者排粪造影的X线表现分级研究
Defecography in patients with prolapse of rectal mucosa lesions: degrees of imaging findings
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摘要:
目的 探讨X线排粪造影在诊断直肠黏膜脱垂病变中的影像学分级方法。 方法 对38例通过X线排粪造影诊断为直肠黏膜脱垂的病例进行影像表现分析,并参考国内外学者的文献进行细化分级。 结果 按照笔者研究的分级方法,38例直肠黏膜脱垂病例X线排粪造影诊断为1级的8例;2级27例,其中2a级15例,2b级12例;3级3例。部分患者同时合并直肠前突等其他征象。 结论 直肠黏膜脱垂病变X线排粪造影的细化分级,可能有助于临床治疗方案的设计。 Abstract:Objective To investigate the classification method of imaging using X-ray defecography in the diagnosis of the prolapse of rectal mucusa. Methods 38 patients(25 females, 13 males; mean age 45 years)who were diagnosed as rectal prolapse by conventional defecography were collected and analyzed. Imagining findings were divided into different degrees according to the domestic and international scholar articles. Results The rectocele imaging findings were divided into three degrees according to the clinical classification. First degree were diagnosed in 8 cases, second degree in 27 cases(2a degree 15 cases, 2b degree 12 cases), third degree in 3 cases. Some patients were complicated with rectocele and other signs. Conclusion Detailed classification of prolapse of rectal mucosa lesions by X-ray defecography may contribute to the designs of clinical treatment. -
Key words:
- Defecography /
- Prolapse of rectal mucosa /
- X-ray
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