胃癌大肠转移的X线钡灌肠表现

Barium enema findings of colorectal metastases from gastric cancer

目的:分析胃癌大肠转移的X线钡灌肠表现。方法:104例胃癌入院术前检查发现结肠转移或胃癌术后转移入院治疗的病例。分析钡灌肠初次发现大肠转移征象的年龄、发现胃癌原发病变距初次发现大肠转移的间隔时间、转移病变的发生部位和病变造成的X线钡灌肠图像上的肠管变形和粘膜面的改变。结果:104例胃癌结肠转移,男67例,女37例。胃癌术前检查中发现结肠转移者32例,术后发现的大肠转移中,多数转移发生在手术后3年内(占91.3%)。胃癌原发灶的肉眼形态BorrmannⅢ型(28例)和BorrmannⅣ型(65例)者占89.4%,组织学中以低分化腺癌和印戒细胞癌为主要成分者占91.3%。X线钡灌肠检查显示大肠转移的好发部位为横结肠(80),其次为直肠(50)。转移灶可累及多节段肠管,其中横结肠中1/3段(47),横结肠左1/3(44),横结肠右1/3(39)和直肠腹膜返折之上(39)。X线显示肠管单侧变形者227处,双侧变形者96处。黏膜面表现为梳齿状黏膜纹聚集改变253处,颗粒结节状改变23处,外压性改变20处,弥漫性改变62处。结论:胃癌大肠转移的好发部位为横结肠和直肠,结肠黏膜面的梳齿状黏膜纹聚集为胃癌大肠转移的主要X线钡剂灌肠表现。

Objective： To analyze X-ray barium enema manifestations of metastasis to colorectum from gastric cancer. Methods： The history of one hundred and four patients who receive preoperative routine radiological examination as suffering from gastric cancer or who be examined because of being diagnosed recurrences or metastases of gastric cancer postoperatively were analyzed. The subjects were evaluated the following： the age of colorectal metastasis initially be found, and the duration between the time which gastric cancer was found and the time which colorectal metastasis was revealed. The involved segment, the deformation of bowel ltunen and the changes of mucosa relief were analyzed.Results：There are 67 males and 37 females in 104 patients suffering from the colorectal metastasis from gastric cancer. The interval between the detection of the primary gastric cancer and colorectal metastasis range from 0 to 128 months, with most （91.3%） in 36 months, with 32 cases in which colorectal metastasis found in the routine examination before gastric operation. The morphology of the primary gastric carcinoma was mostly Borrmann Ⅳ （n = 65） and Borrmann Ⅲ （n = 28）. The histology was poorly differentiated adenocarcinoma and signet - ring cell carcinoma （91.3%）. The most preferably involved site of colorectal metastasis were transverse colon （83）, with rectum （50） secondarily. With the occurrence of involvement was Tm （47）, Ts （44）, Th （39） and Ra （39）. The deformation of bowel lumen on single side was seen in 227 lesions and bilateral in 96 lesions. Mucosal changes showed as parallel tethered relief in 253 lesions, granular in 23 lesions, compression in 20 lesions and diffused change in 62 lesions. Conclusion：The preferable sites of colorectal metastasis from gastric cancer are transverse colon and rectum, the parallel tethered mucosal folds are typical and the most common barium enena findings.