腹腔造影的临床应用

Cinical Aplication of Peritoneography

目的：探讨腹腔造影对盆底腹膜疝的临床诊断价值。方法：对21例存在排便困难患者的腹腔造影和临床资料进行回顾性分析。女性患者检查前阴道内准确放入标志物，检查时采取头高足低位10°～15°，在透视下向腹腔内注入对比剂（60％泛影葡胺40ml内加入2％利多卡因5m1）40ml，经体位翻转后摄取立位及力排正侧位片。结果：21例患者中经腹腔造影检查显示18例有盆底腹膜疝（其中男性1例）。17例女性患者，腹腔造影示Douglas腔底低于阴道标志物上缘水平，力排时Douglas腔底低于耻尾线；依Douglas腔底下降程度分为3度：轻度（下降0．6～1．5cm）14例，中度（下降1．6～3．0cm）2例，重度（下降3．0cm以上）1例。男性直肠膀胱凹底低于直肠中下1／3交界者应视为盆底腹膜疝。结论：腹腔造影能清楚显示腹膜轮廓，对盆底腹膜疝诊断有较大价值。

Objective：To evaluate the clinical application of peritoneography for the diagnosis of pelvic floor peritoneo- cele. Methods：21 patients having Imaging materials of peritoneography were retrospectively analyzed. In female, a marker was accurately placed in the posterior formix vaginae before examination. Tilting the table up to 10°to 15°,contrast medium （5ml 2 % xylocaine mixed with 40ml 60 % angiografin） was injected into peritoneal cavity under fluoroscopy control, the patient was asked to turn over for several times, then spot films with upright lateral and frontal position as well as sitting position with maximum strain were taken. Results： Of the 21 patients having peritoneography, pelvic floor peritoneocele was shown in 18 patients （female,n= 17;male,n= 1）. In female, the inferior margin of Douglas pouch was below the superior margin of the marker within the vagina,which was below the pubococcygeal line at maximum strain in the sitting position. According to the descending level of the inferior margin of Douglas cavity, mild （0.6-1.5cm, n= 14）, moderate （1.6-3.0cm,n= 2） and severe （〉 3.0cm, n = 1） degree were subclassified. In male patient, the inferior margin of rectovesical pouch below the junction of middle-lower rectum should be considered as pelvic floor peritoneocele. Conclusions： Outline of peritoneal cavity can be clearly assessed by peritoneography, which plays an important role in the diagnosis of pelvic floor peritoneocele.