大肠癌致急性完全机械性肠梗阻的X线平片表现

X-ray Features of Acute Complete Mechanical Intestinal Obstruction due to Carcinoma of Large Intestine

目的 探讨大肠癌致急性完全机械性肠梗阻的X线平片表现特征。材料与方法 搜集 3 3例曾于术前作腹部X线平片检查并经手术或纤维结肠镜病理证实为大肠癌致急性完全机械性肠梗阻病例 ,就以下X线表现进行分析 :(1)梗阻近、远侧肠管表现 ;(2 )梗阻部位改变 ;(3 )合并症X线征象。结果 梗阻发生于盲肠及回盲部平面 3例 ,仅表现为小肠梗阻改变 ;升结肠及结肠肝曲平面 6例 ,其中 5例出现盲袢综合征 ;左半结肠及直肠平面 2 4例 ,均显示一般机械性肠梗阻特点 ,其中 1例并盲袢综合征。全组3 3例中 ,14例 (42 .4% )于梗阻部位可见软组织肿块影、肠腔狭窄或局部密度增高影 ,且梗阻部位征象显示与摄片体位有关 ;6例(18.2 % )见肠穿孔或腹腔转移致腹膜炎征 ;4例 (12 .1% )可见慢性肠梗阻表现。结论 大肠癌致急性完全机械性肠梗阻X线平片检查 ,不仅可判断梗阻部位 ,部分病例还可依据梗阻部位表现判断梗阻原因。合理的摄片体位 ,有利于梗阻病因征象的显示。

Objective To investigate the X-ray features of acute complete mechanical intestinal obstruction due to carcinoma of large intestine.Materials and Methods This study included 33 cases with acute complete mechanical intestinal obstruction caused by surgically- and pathologically- proved carcinoma of large intestine. Plain abdominal radiography was performed before surgery in all patients. X-ray findings, including the appearance of the intestinal loops both proximal and distal to the obstruction site, the appearance of the obstruction site and the signs produced by complications, were observed and analyzed. Results Three cases with obstruction at cecum or ileocecum region showed only the signs of small intestinal obstruction. Of 6 cases with obstruction at ascending colon or hepatic flexure, 5 demonstrated blind loop syndrome. All 24 cases with left colon or rectum obstruction showed typical signs of mechanical ileus, in one case blind loop syndrome was also seen. Of total 33 cases, 14 (42.4%) showed soft-tissue-density mass, stenosis of the intestinal canal or localized high-density shadow at the site of obstruction. The revealing of these signs was correlated with the exposure position. Bowel perforation or peritoneal metastasis was complicated in 6 cases (18.2%) and was manifested radiologically as the signs of peritonitis. Four cases (12.1%) showed characteristic signs of chronic obstruction.Conclusion In acute complete mechanical intestinal obstruction secondary to carcinoma of large intestine, plain abdominal film is helpful in judging the obstructive level as well as the cause. Appropriate exposure position is favorable to the revealing of characteristic signs.