影像学检查在膀胱肠瘘中的诊断价值

Imaging diagnosis of enterovesical fistulas

目的:探讨影像学检查在膀胱肠瘘中的诊断价值。方法:回顾分析12例各型膀胱肠瘘的诊断资料,其中膀胱镜检查10例,KUB加IVP9例,膀胱造影8例,钡剂灌肠7例,B超9例,CT7例,MRI3例。结果:KUB加IVP发现3例可疑,无一例确诊;膀胱造影3例因发现造影剂进入肠腔而确诊,3例可疑;钡剂灌肠1例确诊,1例可疑,5例发现结肠内原发病;CT发现例5膀胱壁局部增厚毛糙,其中3例发现膀胱壁外肿块,3例发现膀胱内积气;膀胱镜结合瘘管造影5例确诊,1例可疑。结论:单一检查确诊率较低,对检查结果要综合分析,CT、膀胱造影简便易行,可以作做为初选的手段,膀胱镜结合瘘管造影,可以进一步确定瘘的位置,尿内异物的患者首选钡剂灌肠,CT检查可以为手术方案的选择提供可靠的依据。

Objective：To investigate the imaging diagnosis of enterovesical fistulas, Methods：The information of 12 cases of enterovesical fistulas from cystoscopy , barium enema, cystography, computerized tomography （CT） scanning and KUB IVP was analysised. Results：The positivity rate of the investigations performed were,.KUB IVP got 3 （33.3 % ） suspicious findings,but none was assured; cystography identified the fistulas in 3 （37.5 % ）cases, the other cases were suspicious; barium enema 1 （14, 3 % ）assured and 1 suspicious; cystoscopy combined with fistula-graphy identified the presence and location of fistula in 5 （50%）cases, and 1 was suspicious; CT identified thickened bladder wall in 5 cases including pelvic mass adjacent to bladder wall,and bladder gas in 3 cases. Conclusions：The diagnosis work-up should include a combination of these investigation,and in isolation them may miss the diagnosis. We advocate the CT and cystography as the first line choice; Cystoscopy combined with fistula-graphy can confirm the presence and location of most cases; In cases with faecaluria, barium enema may be a good choice, CT may help planning surgery,