气钡双重低张造影检查在胃部病变诊断
数字胃肠低张双重造影多排螺旋CT检查对胃癌诊断价值
数字胃肠低张双重造影与多排螺旋CT检查对胃癌的诊断价值【摘要】目的通过数字低张双重胃肠造影、多排螺旋ct检查两种影像学检查方法对胃癌的诊断作用进行临床分析比较，为临床提供手术依据。
方法回顾性分析近2年来我院45例经手术和病理证实的胃癌患者的数字胃肠低张双重造影和多排螺旋ct检查的影像学资料。
结果数字胃肠低张双重造影：准确诊断39例，误诊6例；多排螺旋ct检查：准确诊断42例，误诊3例。
结论数字胃肠低张双重造影利用计算机的存储能力和图像后处理功能，提高了图像的质量和病变显示率，对胃内的病变显示清楚，是胃癌有效的影像学检查方法，但不能观察胃腔外周围组织病变及淋巴结转移情况，不能对胃癌进行分期。
多排螺旋ct检查不能观察胃肠道的蠕动、排空等功能性变化。
但能显示病变全貌，可以观察周围病变及周围淋巴结、周围脏器的转移性病变，可以对胃癌进行准确分期，是影像学诊断胃癌必要的补充手段，二者结合可为临床提供可靠的手术依据。
【关键词】胃癌；数字胃肠低张双重造影；多排螺旋ct检查；手术依据文章编号：1004-7484（2013）-02-1003-01胃癌是胃肠道常见的恶性肿瘤之一，近年来发病率呈上升趋势。
胃癌的诊断、分期与治疗方案的选择和预后关系密切。
本文就目前常用的数字胃肠低张双重造影和多排螺旋ct检查两种影像学检查方法与手术结果进行对照分析，以其为临床提供可靠的依据。
1 资料与方法1.1 一般资料收集我院经手术及病理证实的胃癌患者45例，年龄45岁-82岁。
男性37例，女性8例。
患者以上腹痛，食欲减退、消瘦、乏力、黑便或便潜血阳性，既往有慢性胃病史。
术后病理分型，腺癌29例，印戒细胞癌8例，粘液细胞癌5例，未分化癌3例。
1.2 方法数字胃肠低张双重造影：北京万东fy-81数字胃肠机，患者空腹6h-12h。
肌肉注射654-2lomg，口服产气剂一小袋（3g），待5min后，透视下连续吞服浓度为150-200%w/v的钡剂混悬液200ml。
CT和胃双重造影诊断胃癌的临床意义
1404C T和胃双重造影诊断胃癌的临床意义李长启王素凤北京市潮白河骨伤科医院（101300）摘要：目的探讨C T和胃双重造影对胃癌的分期诊断及对临床选择治疗方法的指导意义。
方法回顾性分析了154例胃癌病人的C T和胃双重造影影像资料及手术、非手术的治疗方法。
结果早期癌28例，行R0、R1手术；胃周围淋巴结转移胃癌82例，行绝对根治术及扩大根治术；腹膜转移广泛粘连、脏器转移胃癌30例，2例梗阻症状严重者行姑息手术，其它支持疗法；14例出现腹水者，选择中医药治疗。
结论C T 和胃双重造影方法是诊断胃癌准确、全面的方法，对胃癌治疗方法的选择有指导意义，值得临床推广应用。
关键词：体层摄影术；X线计算机；气钡双重造影；胃癌早期胃癌外科切除效果较好，对分期不明者应尽可能术前判断其切除的可能性，并选择合适的术式，减少不必要的手术及损伤。
笔者总结了1994年2月～2006年4月间收治的154例胃癌患者进行了术前CT和气钡双重造影检查，结合术后及病理证实，对胃癌的表现及可切除性的判断进行了分析，现报告如下：1材料与方法1.1一般情况男86例，女68例，年龄为38岁～75岁，平均年龄51岁，病程30天～120天；临床表现为上腹部剑突下不适、隐痛、恶心、食欲不振、呕血、柏油便、消瘦等，用药不缓解。
1.2方法①胃气钡双重造影：检查前口服产气粉3g，随后服250%（w/v）硫酸钡混悬液50m l，受检者固定于检查台，逆时针旋转三周，使硫酸钡混悬液均匀涂布于胃壁，摄站立正位、左右斜位、仰俯卧位及直立过屈弯腰侧位片各一张。
②CT检查：扫描前口服10%泛影葡胺液1000m l，使胃肠充分显影，静脉注射654～210m g，抑制肠蠕动；病人仰卧，食道下端至脐水平扫描，120m A，120kV，扫描时间为2秒，层厚为5m m，层间距为5m m，必要时减薄扫描。
多层螺旋C T自膈顶向下扫描，容积扫描后5m m层厚重建。
1.3判断标准腔内改变及胃壁活动度判断气钡双重造影为主，腔外改变、淋巴结转移和远处脏器转移以C T检查为主。
低张追加气量气钡双重造影在早期贲门癌诊断中的应用
分枝切断 。 术中采用 ５ 倍手术放大境仔细分离， 发现 阴茎背神
经纤维分枝数 目 ４ １ 枝不 等，其 中 ４枝 ３例 、５枝 ２ －２ ２例、６
枝 ４ 例 、７枝 ６ ５ ４例 、８枝 ３ 例 、９ ２ 例 、１ ６ 枝 Ｏ Ｏ枝 １ 、 １ ０例 １ 枝 ３例 、 １ ２枝 ３例 ，平 均 ７ １枝 。与 张 春 影计 数 活 体 阴茎 背 ． 神 经 纤 维数 目平 均 ７枝 ，基 本 一 致 。
等等 ， 通过对 １ ７ ９ 例患者最长 ５ 月的随访 ， 个 并复习相关资料， 目前 尚未发现一例患者出现上诉并发症 。但 因临床病例有限， 随访时间 尚短，有待进一步临床观察研 究。 上述报告表 明， 选择性阴茎 背神经分枝切断术治疗原发性
早泄安全、有效。 参 考 文 献
奋传入 ） 但 由于患者 的差异 ，药物应 用的副作用使 目前 的 。 治疗方法仍不能满足广大男性患者及男科 医师 的需求 。 本院严 格筛选 阴茎 敏感性较高 的原发性早泄 患者 行阴茎背神经纤维
有学者担心神经具有营养血管和肌 肉的作用 ， 阴茎 背神经 纤维分枝被大 部分切断后，是否会 出现勃起功能障碍 、 性快感
麻木感 ７ 例 。皮下痛性结节 ２例 。无术后出血及切 口感染 。 ９
３ 讨 论
早泄的确切病 因不 明， 至今 已提 出的病因有心理行 为和生
物 性 因 素 ，相 应 的 ，早泄 的治 疗 强 调 心 理 行 为 及 药 物 干预 。现
【］郭 军，辛钟成审校 ．美国泌尿 学会 （ Ｕ ３ Ａ Ａ）早泄药物 治疗
指 导 原 则 【］ 中 国 男科 学 杂 志 ． ０ ４ ８ ｕ ｐ ： ６ ． Ｊ． ２ ０ ，１ ｓ ｐ ｌ —８
改良胃肠低张多层螺旋CT扫描三维重建术对胃肠病变的诊断价值
改良胃肠低张多层螺旋CT扫描三维重建术对胃肠病变的诊断价值李柏振;卢洪波;邓戈锋【期刊名称】《现代医用影像学》【年(卷),期】2015(024)002【摘要】目的探讨口服5.07％等渗甘露醇后行多层螺旋CT胃肠造影(multislice CT enterography MSCTE)检查对胃肠病变诊断的应用价值.材料与方法收集42例2010年1月～2014年12月我院临床初步怀疑有胃肠病变的患者行MSCTE 检查,结合胃、肠道的扩张程度运用多平面重建技术获得MPR、VR、MIP、CPR 等图像,结合仿真内窥镜技术及横断面图像作出分析,对各种胃肠病变影像进行判断并作出诊断;对照分析并统计胃肠MSCTE检查的特异性、敏感性、阳性预测值.结果胃肠道充盈良好,MSCTE能够清楚地显示多种胃肠病变,包括肠内、肠壁的病交,病变与肠外血管及腹内脏器的关系.MSCTE检查结果与临床诊断符合率为90.5％(38/42),无明显并发症.结论 MSCTE是一种非侵入性、简便易行的检查方法,能较好显示胃肠道疾病的方法,对鉴别胃肠道病变及判断病变与腹腔内其他脏器的关系有较大的临床应用价值.【总页数】3页(P246-247,257)【作者】李柏振;卢洪波;邓戈锋【作者单位】东莞市沙田医院,广东东莞523981;东莞市沙田医院,广东东莞523981;东莞市沙田医院,广东东莞523981【正文语种】中文【相关文献】1.改良低张气钡双重数字胃肠造影对小肠病变的诊断价值2.改良胃肠低张多层螺旋CT扫描三维重建术对胃肠病变的诊断价值3.改良胃肠低张多层螺旋CT扫描三维重建术对胃肠病变的诊断效果4.多层螺旋CT小肠低张造影在胃肠道病变诊断中的价值分析5.多层螺旋CT小肠低张造影在胃肠道病变诊断中的价值分析因版权原因，仅展示原文概要，查看原文内容请购买。
钡餐检查、超声胃造影检查、胃镜检查对胃下垂诊断价值的比较
钡餐检查、超声胃造影检查、胃镜检查对胃下垂诊断价值的比较王维【摘要】目的：探讨钡餐检查、超声胃造影检查、胃镜检查在胃下垂诊断中应用价值的比较。
方法：对2008-2012年间在我院影像科确诊检出4380例胃下垂患者的钡餐检查、超声检查、内镜检查检出率进行分析。
结果：经过X线钡餐检查确诊4380例胃下垂患者，全部做胃超声造影检查，检出胃下垂4200例，与钡餐检查比较检出率95．9％，4380例患者中有1314例做胃镜检查，其中检出胃下垂653例，检出率49．7％。
结论：对胃下垂的诊断方法中钡餐检查检出率高于超声检查，超声检查检出率高于内镜检查。
【期刊名称】《医学理论与实践》【年(卷),期】2013(000)022【总页数】2页(P3038-3039)【关键词】胃下垂;X线钡餐检查;超声胃造影;胃镜【作者】王维【作者单位】河南省太康县人民医院 461400【正文语种】中文【中图分类】R572.1随着科技和医学技术的发展及提高，对胃下垂的诊断检查方法中不仅仅局限于X线钡餐检查，超声胃肠造影技术的进展与提高，使经胃超声造影对胃下垂的检出率明显提高，由于内镜技术的广泛应用普及，胃镜检查对胃下垂的检出也明显提升。
故本文笔者对X线钡餐造影检查，胃超声造影、胃镜检对诊断胃下垂的临床应用价值进行对照研究。
1 资料与方法1.1 一般资料搜集2008－2012年经过我院影像科X线钡餐检查以及临床确诊为胃下垂患者4 380例，男2 000例，女2 380例，最小年龄9岁，最大年龄89岁，平均年龄39岁，4 380例患者全部做超声胃造影检查，部分患者做胃镜检查。
以上患者出现不同程度餐后下腹部膨隆、消化不良等症状，有时左侧腹部有隐痛，运动后牵拉疼。
1.2 钡餐检查全组病例接受X线上消化道钡餐检查，我院采用日本产日立牌DR－1000 800MA数字胃肠机，采用山东长清制药厂生产的硫酸钡（Ⅰ型）干混悬剂，医用硫酸钡，浓度1∶1.5或者用150g钡加水200ml，行直立位平静呼吸状态下观察及点片，患者不注射低张药物，透视下观察胃动力以及张力情况。
胃肠道钡餐检查护理要点
4.禁忌症 （1）急性胃肠道出血及胃肠道穿
孔。
（2）肠梗阻。
三、结肠低张气钡双重造影
（一）适应症 1、结肠肿瘤、息肉。 2、结肠慢性炎症。 3、结肠先天性异常。 4、结肠梗阻及肠套叠。
（二）方法
1 .术前准备
（1）检查前日不吃有渣食物。
（2）检查前晚服缓泻剂。
（3）检查日晨空腹并清洁洗肠
（3）气钡双重对比造影：口服钡剂前吞服产气粉， 使食管粘膜结构显示更清晰。
（4）食管下端、胃第贲门部病变必要时取卧位， 病变显示更清晰。
（5）食管异物时，口服浸以钡剂的棉花球，钡棉 受阻部位体示异物所在。
禁忌症 1.食管静脉曲张大出血。 2.腐蚀性食管炎的急性期。 3.疑食管破裂、穿孔或食管气管瘘
发泡剂。 2.造影剂：钡剂悬液。 3.常规造影方法： （1） 同食管造影。 （2） 立位口服钡剂观察食管食管情况。 （3） 口服少量钡剂，于不同体位（站立位、卧位、
俯卧）观察食管各段的双对比像。 （4） 给予钡剂，现示胃的大体轮廓及充盈情况。 （5） 观察十二指肠各部的形态、轮廓、蠕动情况。
1.结肠穿孔。 2.结肠急性炎症。
谢谢！
2.造影剂：钡剂悬液。
3.造影技术：
（1）常规胸、腹部透视。
（2）插管：病人屈膝左侧卧位，将肛管插入直 肠，深约10cm。
（3）常规造影灌肠造影法：缓慢注入造影剂至 横结肠中部时停止注钡并注入适量气体以驱使钡 剂充盈全部结肠，嘱咐病人在检查床上左右转动 使钡剂均匀涂布于结肠壁上。
（三）禁忌症
胃肠道与周围组织器官之间缺乏 天然对比，需借助于造影才能观察。 通常采用口服造影剂和插管注入造 影剂使其显影，来观察胃肠道各部 位的形态结构及动力情况。
双重造影产气剂说明书
双重造影产气剂是一种用于诊断检查的药物，适用于胃溃疡、十二指肠溃疡、急性胃粘膜病变、复合性溃疡、反流性食管炎等疾病的诊断检查，以及胃癌早期发现的诊断和全消化道其它疾病的诊断检查。
双重造影产气剂的主要成分包括枸橼酸（含水）、碳酸氢钠和消泡剂，为白色及类白色的混合颗粒，无臭，味酸咸，遇水溶解并产生大量气泡。
使用时，应按照医生的建议或说明书的指引进行使用。
需要注意的是，双重造影产气剂是一种处方药，需要在医生的指导下使用。
对于有过敏史、严重肝肾功能不全、胃肠道出血等疾病的患者，在使用双重造影产气剂时应特别注意。
在使用双重造影产气剂过程中，如果出现任何不适症状或不良反应，应及时向医生报告。
此外，双重造影产气剂应存放在阴凉干燥处，避免阳光直射和受潮。
胃肠道造影检查怎么注意
2021年甘肃省武威第一中学高三英语模拟试题及参考答案第一部分阅读（共两节，满分40分）第一节（共15小题；每小题2分，满分30分）阅读下列短文，从每题所给的A、B、C、D四个选项中选出最佳选项ADuring ancient times, children didn’t have smartphones, iPad or computers to entertain themselves. Instead, they came up with interesting games to play.★Stone ballsDuring the Qing Dynasty, kicking a stone ball around was a popular sport in the northern part of China, and it was often played in the winter to protect kids from the cold. Stones were carved into small balls and kicked along with feet. In 1999, the sport was included in the 6th National Ethnic Group Traditional Sports Meeting held in Beijing.★Flying kitesKites have quite a long history. The earliest kites were made of wood, instead of paper. Nowadays, the four most famous kites are the Beijing kite, Tianjin kite , Weifang kite and Nantong kite, of which each has distinctive features. The kite which resembles a swallow is a well-known Beijing style.★Hide-and-seekHide-and-seek is a traditional game for children, popular around the nation. There are two ways to play: covering a child’s eyes while other kids run around to tease(戏弄) him or, more commonly, participants hide and one child must try to find them.★Playing diabolosA diabolo is always made of wood or bamboo and has empty space in the center. By juggling(边抛边接) the diabolo on the rope, the high-speed spinning diabolos will make a sound like a whistle. Playing diabolos is an interesting folk game, especially popular in North China. Playing diabolos was also included in the first group of national intangible cultural heritage(非物质文化遗产).1.Why did ancient children often play stone balls in the winter?A.To practice their feet.B.To warm themselves.C.To train their skills.D.To relax themselves.2.Which kites are swallow-shaped?A.Weifang kites.B.Tianjin kites.C.Beijing kites.D.Nantong kites.3.Why does playing diabolos make a sound?A.Because the diabolo’s center is empty.B.Because the high-speed spinning diabolo is light.C.Because the diabolo is equipped with a whistle.D.Because ropes’ surface moves against the diabolo’s.BAn anti-obesity program for Australian girls didn’t lead to any improvements in their diet, physical activities or body weight a year later, according to a new report.Findings from the school-based intervention (介入), which involved exercise sessions and nutrition workshops for lower-income girls, are the latest disappointment in a lot of research attempting tohead offadult obesity and the disease risks that come with it.Especially during the middle-and high-school years, girls’ physical activity reduces obviously, according to lead researcher David Lubans, from theUniversityofNewcastleinNew South Wales,Australia. He said, “In the future we need to make the programs more interesting and exciting and present information in a way that is meaningful to adolescent girl.”Lubans and his workmates conducted their study in 12 schools in low-income areas ofNew South Wales. At the start of the study, girls in both groups weighed an average of close to 130pounds, with about four in ten considered overweight. Over the next year, adolescents in the intervention group were given pedometers (计步器) to encourage walking and running and invited to nutrition workshops and regular exercise sessions during the schoolday and at lunchtime. Participation in some of those activities were less than ideal. For example, the girls went to only one-quarter of lunchtime exercise sessions, and less than one in ten completed at-home physical activity or nutrition challenges, the researchers reported. At the end of the year, girls in both groups had gained a similar amount of weight and there was no difference in their average body fat.Preventive medicine researcher Robert Klesges said that although some anti-obesity programs have helped adults lose weight, the teen population has always been a source of failure for researchers. “The common belief is: nothing works,” he said. “And we have got to get beyond that.”“We need to think outside the box,” said Klesges, who wasn’t involved in the new study. “That could include learning from what has worked in adult studies, such as giving meal replacement drinks or prepared foods to teens who have trouble making changes to their diet. Or, it could mean using a “step-care” method — rather thanresearchers or their doctor telling them to keep doing the same thing.” Klesges said.4. The underlined words “head off” in Paragraph 2 can best be replaced by “________”.A. damageB. defendC. preventD. affect5. The methods used in the program to stop obesity don’t include ________.A. walking and runningB. inviting them to nutrition workshopsC. joining exercise sessions regularlyD. giving meal replacement drinks6. The main reason for the failure of the anti-obesity program is probably that ________.A. the participants didn’t take an active part in itB. the program was not interesting and exciting to participantsC. the participants didn’t get extra nutrition or exercise helpD. the program didn’t pay attention to healthy exercise7. What can be inferred from the last paragraph?A. As researchers, it is important to have creative research methods.B. Researchers need to give meals or prepare foods to participants.C. Teen girls have no difficulty in making changes to their diet.D. Some ant-obesity programs have not helped adults lose weight.CByteDance（字节跳动）Group’s TikTok, an overseas version of Chinese short video sharing app Douyin, faces an existential crisis in the United States, as murmurs of a “crackdown”（强制取缔）from the White House forced the Chinese company toengage in talks on selling its US business to Microsoft.TikTok is the fastest-growing registered global mobile internet app, with more than 100 million users, and its rapid growth, especially in the US, is seen as a threat to Facebook. The US government has long viewed globally competitive Chinese high-tech companies including Huawei as a threat and done whatever it could to crack down on（打击）them in the name of “national security”.The US government has not introduced any specific policy against TikTok only threatened it through a number of unclear statements.According to the latest media reports, Microsoft is prepared to press ahead withthe negotiations to take over TikTok’s US operations and complete the negotiations by Sept 15, following talks between Microsoft CEO SatyaNadella and US President Donald Trump.This means that TikTok will have to hand its fate over to some unpredictable power, and even have to sell its assets without the option of setting a price.The US government has failed to find a reasonable legal excuse to deal with TikTok. All private data of TikTok’s US users are stored in the US and are unlikely to be transferred. Considering the US government is trying to deal with TikTok in a political way, TikTok should consider incorporating（合并）the dispute into the US legal process to assert（坚持）its legal rights and interests.TiKTok’s core value lies in its unique algorithms,a product of artificial intelligence that represents the expertise of Chinese engineers and programmers with high-value intellectual property.The US government’s move, which has forced ByteDance to sell TikTok to a US company, is similar to a forced technology transfer and an example of the US’ openseizureof Chinese intellectual property.If ByteDance sells TikTok to a US company for “security reasons", that would set a dangerous precedent, motivating other countries where TikTok operates to follow the US administration's example and cause a chain reaction.ByteDance is a young Chinese private company that cannot deal with a political game played by the US. But as a Chinese company that has gone global, ByteDance has reasons to take up legal means to defend its legal rights. The Chinese government can also consider examining whether the technology transfer in the deal violates China’s law and harms the country’s national interests.8. What is the most valuable as for TikTok?A. Its global popularity.B. Its artificial intelligence.C. Its registered global mobile internet app.D. Its private data of TikTok’s worldwide users.9. Why does the American government force the Chinese company to hand over TikTok’s US operations to a US company?A. Out of so-called political reasons.B. Out of so-called debt reasons.C. Out of so-called technical reasons.D. Out of so-called security reasons.10. What does the underlined word “seizure”probably mean in Para. 8?A. An untrue spoken statement about someone.B. The use of legal authority to take sth from sb.C. The crime of stealing sth from a person or place.D. The act of trying to hurt somebody using physical violence.11. What can be the best title for the news report?A. TikTok must defend its rights legallyB. TikTok is seen as a threat to FacebookC. ByteDance has to sell TikTok to a US companyD. ByteDance agrees to transfer technologyDAn ancient tomb was recently discovered in southern Siberia in which there may be treasure, priceless objects, and the 3, 000-year-old remains of an ice mummy.Swiss scientist Gino Caspari with the University of Bern was looking carefully at the pictures of the area in the Russian Tuva Republic, when he came across what appeared to be a tomb. It is a tomb of the Scythians, an ancient group of Eurasians.This summer, together with researchers from the Russian Academy of Sciences and the Hermitage Museum, a dig at the site not only proved Caspari's idea, but told us the site is the largest and oldest of its kind ever discovered in what's increasingly known as the “Siberian Valley of the Kings.”While any discovery dating back to a period between the Iron Age and Bronze Age is exciting, it's the nature of this site that makes scientists want to begin carefully clearing away the layers of rock and earth. First, the tomb appears to have never been dug, because it is in a Siberian wetland faraway from the nearest place where people live. Second, and most important, is its possible resting place under a thick layer of permafrost.“There's permafrost in the area,” Caspari said. “There are really only a handful of permafrost tombs and very few that have not been damaged, where there have been ice mummies in good condition, and all the things in the tomb are untouched.”While not as large, other tombs discovered in the area have produced fantastical treasures and objects, including thousands of gold objects and other things about the past. By studying all these tombs, researchers hope to have a better understanding of the Scythian people.Caspari said his team is in a race against time to uncover the tomb and find out its secrets. “We now have to act fast,” he said, “because with the rising temperatures, the permafrost could melt and damage all the things in that tomb. And these are things that are over 3,000 years old, that look like new, like they were put there yesterday.”12. How did Caspari discover the tomb?A. By studying pictures.B. By visiting a Russian area.C. By talking with Russian researchers.D. By comparing other scientists,ideas.13. Why has the tomb remained untouched?A. It is covered by a lot of rocks.B. It is well kept by the Scythians.C. It is too small to draw attention.D. It is hidden in a wild cold place.14. Why do scientists want to uncover the tomb?A. To better protect the tomb.B. To save the treasures inside.C. To learn more about the Scythians.D. To have a good understanding of mummies.15. Why is Caspari's team racing against time to dig the tomb?A. The tomb is too old.B. It is getting hotter and hotter.C. Some treasures are being damaged.D. They want to save time for other tombs.第二节（共5小题；每小题2分，满分10分）阅读下面短文，从短文后的选项中选出可以填入空白处的最佳选项。
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气钡双重低张造影检查在胃部病变诊断
中的应用价值（附134例报道）
五0四医院放射科许福德刘维吴彩玲王建雄
【摘要】目的：通过134例上消化道气钡双重低张对比造影的分析，对胃部各种疾病诊断方面与常规法相比的优越性。
方法：应用气钡双重低张造影方法，使胃粘膜充分展平，钡剂充分涂布于胃壁，可多轴位动态观察胃腔情况。
结果:胃溃疡表现为不同大小的钡斑；胃癌表现为多条腔壁线的重叠甚至草帽征及充盈缺损；慢性胃炎表现为腔壁线的分段平直和胃小区胃小沟的变形。
结论：气钡双重低张造影对胃部疾病尤其是细小病变和早期病变较传统钡餐有明显的优越性。
【关键词】胃；气钡双重低张造影；X线
胃气钡双重低张造影检查是胃部病变的主要检查方法之一。
此检查方法的普及，明显提高了胃部病变的检出率。
现对我科134例进行气钡双重低张造影检查的患者进行总结。
1 资料与方法
本组上消化道胃气钡双重低张造影134例，其中男63例，女71例，年龄最小7岁，最大85岁，平均年龄55.6岁。
慢性胃炎80例，胃溃疡26例，胃癌、残胃癌19例，正常9例。
患者禁食水12h，检查前5～10min肌注低张药物654-2 10mg,口服产气粉3克（将产气粉碾成细沫，以防大颗粒影响病变的观察），使胃充分扩张，在意大利GMM1000mA数字X光机监视下口服浓度为150～200%(w/v)的硫酸钡混悬液约100ml，让患者向左翻身两周，使钡剂均匀涂抹于胃壁，随后分别采取左右斜位、仰卧位、俯卧位及站立位动态观察，随时采集图像。
2 结果
本组通过胃气钡双重低张造影检出胃溃疡26例，其中5例为多发复合性小溃疡，表现为气体衬托下的细小钡斑及锯齿状腔壁线，其余为较大溃疡（大于0.5cm），表现为大的钡斑、粘膜纠集及切线位的腔壁线中断（如图1）。
慢性胃炎80例，均表现为胃小区胃小沟的变形、大小不等、消失或显示不清，腔壁线分段平直（如图2）。
胃癌13例，表现为环圈征、指压迹征，粘膜中断、破坏，切线腔壁线内凸形成反“C”形或“D”形内壁，同时伴有胃壁僵硬，有不规则溃疡时表现为靶征(如图3)
图1：胃小弯侧溃疡，钡斑及粘膜纠集；
图2：慢性胃炎，胃小区胃小沟消失，腔壁线分段平直；
图3：胃窦癌，可见环圈征及粘膜破坏中断。
3 讨论
3.1胃气钡双重低张造影的技术要求：
上消化道气钡双对比造影对影像学设备要求较高，上述病例都是用意大GMM1000mA数字X线影像系统检查的，除了多轴位动态观察及实时数字点片外，还可以应用后处理技术，能够清楚地显示出胃部细小病变。
还有低张药物应用及足量的充气，使胃能够扩张良好，粘膜皱襞展平，显示粘膜面的细微结构。
其次应用高浓度、低粘度的钡剂[浓度为150～200%（w/v）,剂量一般为100ml]。
可根据胃的容积和储留液量来做适当调整。
多次翻转病人，让钡剂反复冲刷胃粘膜面，以达到均匀涂布的目的。
3.2 胃气钡双重低张造影在胃肠疾病中的优越性：
胃双重低张对比造影是近年来胃部x线检查的一项重大技术改进。
多组研究资料表明，与纤维胃镜相比，传统常规钡餐检查的漏诊率达20～40%，而双对比造影的漏诊率仅为6～7%，接近于内窥镜的诊断效果[1]，因此双重低张对比造影成为了现代胃部X线检查的重要手段。
实验表明，常规钡餐检查造成漏诊误诊的一个主要原因是由于粗大的粘膜纹存在。
这种粗大但又属于正常的粘膜皱襞往往掩盖了细小病灶的存在，并且钡剂在皱襞间的积存可造成病变的假象，这种因素造成误诊漏诊约占42％[2]。
然而应用了低张和足量的充气扩张，消除了粗大的粘膜纹的干扰，从而充分发挥双重造影的优点，可更有效的提高诊断正确率是显而易见的。
通过展开的胃粘膜面的不同改变可及早发现不易发现的小病灶。
如胃炎腔壁线的分段平直，胃小区的大小不等。
肿物的草帽征，溃疡的钡斑等征象。
尤其是在早期胃癌的诊断中显示其显著的优越性[3]。
胃气钡双重低张造影技术的发展，提高了X线对胃肠道疾病的诊断能力。
推广和应用胃气钡双重低张造影是现代胃部X线检查的重要方向。
应当看到，尽管近年来纤维胃镜的应用日益广泛,但X线检查的无痛苦、危险小、整体观察、动态观察的特点是纤维胃镜所难以达到的。
到目前为止，气钡双重低张造影检查仍然是胃部疾病诊断的重要和首选方法。
参考文献
[1]沈国强，胃双重造影，放射诊断讲座[M].1993.63
[2]郭爱华，胃溃疡的相关特殊X线征象分析[J]，医学影像学杂志，2005.15(8)：689－691
[3]吴恩惠,尚克忠中华影像医学－消化系统卷[M].人民卫生出版社,2002.。