根据钡剂到达回盲部时间谈小肠钡餐检查对小肠疾病筛查的合理应用分析

Analysis on the Clinical Application of Radiology Based on the Arrival Time of Oral Contrast to Ileocecal Junction during X-ray Barium Meal Examination

目的:规范X线小肠钡餐检查对小肠疾病筛查的方法,提高其临床应用价值、减少不必要的检查程序、降低患者的X线辐射剂量。方法:收集因消化道症状行X线小肠钡餐造影检查的病例152例(除外有消化道手术史及先天畸形病例),根据罗马Ⅲ标准分为正常组、功能组和器质组3组,采用相同方法记录钡剂到达回盲部时间。采用单因素方差分析正常组、功能组和器质组之间,单纯性腹痛、便血、腹胀、腹泻及其他主要症状之间钡剂到达回盲部的时间差异性。结果:正常组、器质组及功能组钡剂到达回盲部时间分别为(214.91±93.64)min(、210.14±121.89)min、(63.52±29.63)min,正常组与器质组钡剂到达回盲部的时间均长于功能组(P<0.05),正常组与器质组间钡剂到达回盲部的时间无统计学差异(P>0.05)。以腹泻为主要症状的病例造影剂到达回盲部的时间为(85.20±85.06)min,短于单纯性腹痛、便血、腹胀及其他主要症状(含肿瘤)病例(P<0.05)。X线钡餐检查有48.68%(74/152)的患者受益较少,会受到不必要的X线辐射;X线钡餐检查有助于其余病例的诊断。结论:以腹泻为主的患者、功能性肠道疾病患者钡剂到达回盲部时间短,小肠钡餐造影检查时应减少不必要的检查程序,实现X线检查合理应用,达到放射检查正当化和防护最优化,保护患者健康。

Objective：To standardize the procedure of initial screening disease of digestive tract by the arrival time of oral contrast to ileocecal junction during X-ray barium meal examination to increase the clinical significance,and decrease the X-ray diagnostic series and the patients＇x-radiation.Methods：One hundred and fifty-two patients with diseases of digestive tract and without the history of operation on digestive tract or digestive tract congenital malformation were enrolled into our study,and were divided into three groups such as normal group,functional disease group,and parenchymal disease group according to Rome Ⅲ Standard.All patients underwent X-ray barium meal examination,and the arrival time of oral contrast to ileocecal junction was recorded in a way in each patient.One-factor analysis of variance was used to test the differences in the arrival time between two groups,and different symptoms including abdominal pain,hemafecia,abdominal distension,diarrhea and other symptoms such as digestive system neoplasms.Results：The arrival time of oral contrast to ileocecal junction in normal group,parenchymal disease group,and functional disease group were 214.91±93.64min,210.14±121.89min and 63.52±29.63min,respectively;and the arrival time in both normal group and parenchymal disease group were significantly longer than in functional disease group（all P0.05）,whereas there was no significant difference in the time between normal group and parenchymal disease group（P0.05）.In patients with diarrhea,the arrival time was 85.20 ± 85.06 min,and the time in functional disease group was also significantly shorter than in patients with diarrhea,abdominal pain,hemafecia,abdominal distension and other symptoms（all P0.05）.In all enrolled patients,48.68% patients（74/152） benefit little from X-ray barium meal examination due to receipt of redundant roentgen irradiation during the examination,the remaining could be diagnosed by this imaging procedure.Conclusion：In patients with functional disease of digestive tract,the arrival time of oral contrast to ileocecal junction during X-ray barium meal examination can be shorter than in any other disease of digestive tract,and this procedure can be helpful for initial screening the former.Additionally,the X-ray diagnostic series should be decreased to reduce the patients＇x-radiation.