摘要
目的:探讨口服4%碘海醇精粉糊状造影剂螺旋CT扫描结合内镜检查在诊断食管癌的临床应用价值.方法:取30%碘海醇注射液10mL用95℃以上开水稀释成4%低浓度碘剂75mL,加入魔芋精粉10g充分搅拌,即制成4%碘海醇精粉黏稠糊剂.患者先口服1/2量糊状造影剂,再将剩下造影剂嘱咐患者大口含于口中,定位像准备好后,嘱患者快速咽下后立即屏气扫描.结果:113例食管癌患者全部行4%碘海醇精粉糊状造影螺旋CT扫描.其中初诊食管癌71例,诊断准确64例,准确率90.1%,显著高于常规CT平扫68%;术后复查15例,出现吻合口狭窄2例,局部复发1例;放疗后复查21例,13例可见管壁僵硬,其中11例伴有肿块及管壁增厚,支架植入术后6例;发现纵隔淋巴结转移37例,肺内转移23例.螺旋CT造影对腔内外病变,肿块形态、大小,邻近侵犯及肿块与大血管的关系,纵隔淋巴结和肺转移等均显示清楚.但对管壁增厚不明显、肿块形成不明显的早期食管癌显示有限.对内镜插管困难和食管外压性病变所示食管梗阻,螺旋CT扫描明显优于内镜检查.结论:4%碘海醇精粉糊可用作螺旋CT扫描结合内镜检查诊断食管癌.
AIM：To evaluate the clinical value of pasty iohexol （4%） used as an oral contrast agent in spiral computed tomography （CT） for diagnosis of esophageal cancer.METHODS：Ten milliliters of 30% iohexol injection were diluted to 75 mL with water at a temperature above 95℃.Ten grams of konjac flour were then added and mixed fully to result in pasty iohexol （4%）.A half dose of pasty iohexol was initially given to the patients.Subsequently,the patients were instructed to hold another half-dose in the mouth until the command to swallow was given. Spiral CT scan was then performed. RESULTS： A total of 113 esophageal cancer patients underwent pasty iohexol-enhanced spiral CT scan, of which 71 were initially diagnosed as esophageal cancer. The diagnostic accuracy of pasty iohexol-enhanced spiral CT was significantly higher than that of conventional CT （90.1% vs 68%）. Postoperatively, pasty iohexol- enhanced spiral CT scan was performed in 15 patients. It was found that two developed anastomotic stenosis and one developed local recurrence. After radiotherapy, 21 patients underwent pasty iohexol-enhanced spiral CT scan. It was found that 13 patients developed a rigid esophageal wall, of which 11 had mass lesions and thickened wall and 6 underwent stent implantation. Of 64 esophageal cancer patients, 37 developed mediastinal lymph node metastasis, and 23 developed pulmonary metastasis. Pasty iohexol-enhanced spiral CT can clearly show luminal and extraluminal lesions, tumor shape and size, adjacent invasion, relationship between tumor mass and great vessels, and mediastinal lymph node and lung metastasis. However, it has some limitations in early esophageal cancer patients who do not develop thickened wall and significant mass lesions. Pasty iohexolenhanced spiral CT is superior to endoscopy in patients who have difficulty in inserting the endoscope into the esophagus or have esophageal obstruction due to extrinsic lesions. CONCLUSION： Pasty iohexol （4%） is useful as an oral contrast agent in spiral CT for diagnosis of esophageal cancer.
出处
《世界华人消化杂志》
CAS
北大核心
2009年第28期2940-2943,共4页
World Chinese Journal of Digestology
关键词
食管肿瘤
体层摄影术
X线计算机
造影剂
内镜
Esophageal cancer
Computed tomography
X-ray computed tomography
Contrast agent
Endoscopy
