小肠钡餐造影对肠易激综合征的诊断价值

目的 观察小肠运动功能对肠易激综合征（IBS）的诊断价值。方法 对46例IBS进行小肠钡餐造影，观察其小肠运动功能，并与15例正常组对照。结果 小肠运动力≤2h36例（78．2％），2-6h 9例（19．6％），〉6h 1例（2．2％）；张力增高、黏膜皱襞收缩为主21例（45．7％），张力减低、黏膜皱襞舒张为主2例（4．3％），两者相间14例（30．4％）；分泌增多27例（58．7％），小肠积气3例（6．5％）。结论 IBS的小肠钡餐造影有功能性X线改变，这对临床诊断有帮助。

回肠镜检、回肠末端活检正常且结肠镜检正常或无明显异常的患者无需小肠钡餐造影检查

Background: There is an increase of reliance on ileoscopy in preference to small-bowel barium follow-through in the diagnosis of terminal ileal Crohn disease. In this study the role of small-bowel barium follow-through after a normal or unremarkable ileocolonoscopy was investigated. Methods: A retrospective analysis of all patients who had a colonoscopy followed by a small-bowel barium follow-through over a 7-year period was performed. Patients with a previously established diagnosis of inflammatory bowel disease and those who had colonoscopic evidence of inflammatory bowel disease were excluded. Results: Of the 96 patients who had a normal ileoscopy and normal or unremarkable colonoscopy, 3 had abnormalities detected at small-bowel barium follow-through. Two patients had abnormal terminal ileal biopsies, although the terminal ileum appeared macroscopically normal. The small-bowel barium follow-through helped to establish the diagnosis of Crohn disease. The other patient presented changes consistent with a previously established diagnosis. Of the 47 patients who had a normal or unremarkable total colonoscopy without ileoscopy, 1 had abnormalities detected at small-bowel barium follow-through consistent with a previously established diagnosis. Conclusions: Small-bowel barium follow-through is rarely required in patients who have had a normal ileoscopy and terminal ileum biopsy and a normal or unremarkable colonoscopy. It should only be performed if there is a very high index of suspicion of small-bowel pathology. In patients with suspected Crohn disease, it is important to take terminal ileum biopsies even if the ileum appears macroscopically normal at ileoscopy.

小肠灌注双对比造影法的改良与临床应用

目的小肠疾病临床并不少见，只因缺乏较理想的检查方法其疾病检出的阳性率较低．我们将其传统的小肠导管及插管方法做了改良，来观察临床应用的效果．方法采用血管造影用Teflon导丝引导下推送Bilbao-Dotter导管，因心血管导管用的导丝较细，柔韧度好，下管顺利．同时采用分段加压，多体位撮片方法，进行小肠插管钡餐灌注双对造影方法，检查小肠疾病结果采用改良的小肠灌注双对比造影法全过程只需20min，下管成功率达100％，比传统方法检查时问缩短3h左右，大大提高了小肠疾病诊断阳性率．结论改良的SBE检查方法简单，操作方便，安全可靠，时间短患者无痛苦，是一种较好的小肠疾病的诊断、鉴别诊断及治疗的好方法．

不明原因消化道出血诊断进展

不明原因消化道出血（ obscure gastrotintestinal bleeding，OGIB）发病率约占消化道出血的5％，由于诊断的困难，曾使临床医生面临巨大挑战。近年来，由于内镜诊疗水平和放射学技术的飞速发展，OGIB诊疗水平有了很大提高。本文对 OGIB 的诊治进展做一综述。