服产气粉及水在胃癌多层螺旋CT扫描中的应用

Application of oral gas-producing crystals and water in the CT examination of gastric multislice CT examination

目的探讨采用服水及产气粉充分扩张胃在胃癌多层螺旋CT检查(Multislice spiral computed tomography,MSCT)中的应用。方法 67例经胃镜活检证实胃癌患者因术前分期需要行CT增强扫描,全部患者均签署书面知情同意书进入本研究。扫描前患者口服产气粉,先行气充盈平扫,而后服水500～1000ml,通过改变体位使病灶被水淹没再行三期动态增强。前者主要用于虚拟胃镜(Virtual gastroscopy,VG),后者主要用于CT血管成像(CTA)和分期。结果全部67例患者均成功完成检查,VG于61例(91.04%)患者中显示病灶,获得图像与胃镜相似显示率。CTA对胃左动脉显示率100%,胃右动脉显示率为52.24%,同时检出12例腹腔干和肝动脉变异,CTA能较好显示肿瘤与邻近血管的解剖关系。与手术病理结果相比较,采用多平面重组(MPR)对肿瘤局部侵犯评价准确性为86.89%(53/61),显著高于横断图象的63.93%(39/61)(P=0.001)。MPR对淋巴结分期的准确性为70.49%(43/61),与横断图象无显著差异。结论结合服产气粉和水能使胃得到充分扩张,适合于VG显示病灶和CTA、动态增强进行肿瘤分期,值得在临床推广。

Objective To investigate the role of oral gas-producing crystals and water in the CT examination of gastric multislice.Methods 67 consecutive patients with gastric cancer,which was confirmed by biopsy through gastroscopy,underwent CT plain scanning with oral gas-producing crystals,followed by dynamic enhanced CT after oral 500~1 000 ml water.The former was used to produce virtual gastroscopy（VG）,and the later was used to CT angiography（CTA） and staging.Results CT examination was successfully completed in all the 67 patients.VG detected lesions in 61 patients（91.04%）,which was similar with endoscopy.CTA visualized left gastric artery in 67 patients（100%）,right gastric artery in（52.24%）,and detected anomy of celiac and hepatic artery in 12 patients.Comparison with histopathological examination,MPR obtained accuracy for T staging of,which was higher than that for transverse images [63.93%（39 of 61）]（P=0.001）,and accuracy for lymph node（N） staging of 70.49%（43 of 61）,which was similar with transverse images.Conclusion CT with oral gas-producing crystals and water can distend sufficiently,which facilitates VG,CTA and dynamic enhancement.It is worthy of recommendation.