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目的:评估细胞减灭术加腹腔热灌注化疗术前腹膜转移癌(PC)患者的肠管蠕动状况、肠系膜浸润程度。方法:根据血清CA125、CA199及CEA指标和多层螺旋CT增强加多平面重建技术,确诊PC 30例,原发病变包括胃癌、结直肠癌、卵巢癌、腹膜假性黏液腺瘤、阑尾恶性黏液腺瘤、胆囊癌、肺癌,口服泛影葡胺后,行胃肠道造影检查。结果:30例患者的造影检查显示:10例(30%)局限性肠管受侵,管腔显示稍窄,黏膜变形;3例(10%)小肠系膜明显挛缩,呈球状或花瓣状改变,位置固定,肠管黏膜消失;16例(53.3%)肠管蠕动正常,肠管轻度聚集现象,肠管黏膜平坦;4例(13.3%)小肠系膜无挛缩征象,肠管蠕动正常,分布均匀,肠管黏膜形态正常;与术中所见相近。结论:PC患者术前行胃肠道碘水造影,可全面了解胃肠道蠕动状况及肠系膜浸润程度,指导临床筛选合适的手术病例。
Objective: To evaluate the intestinal peristalsis and the degree of mesenteric invasion in patients with peritoneal metastasis (PC) before cytoreductive surgery and intraperitoneal hyperthermic perfusion chemotherapy. Methods: According to the serum CA125, CA199 and CEA indexes and multi-slice spiral CT plus multiplanar reconstruction, 30 cases of PC were diagnosed. The primary lesions included gastric cancer, colorectal cancer, ovarian cancer, peritoneal mucinous adenoma, Adenoma, gallbladder cancer, lung cancer, oral meglumine diatrizoate, gastrointestinal imaging. Results: The angiographic examination of 30 patients showed that 10 cases (30%) had limited intestinal involvement, the lumen was slightly narrowed and the mucosa was deformed. The small intestinal mesentery of 3 patients (10%) showed obvious contracture with spherical or petaloid changes, The intestinal mucosa disappeared in 16 cases (53.3%). The bowel mucosa was mildly aggregated and the bowel mucosa was flat. The intestinal mucosa was flat in 4 cases (13.3%), the contracture of intestinal mesentery was normal, the intestinal peristalsis was normal, Normal; similar to the intraoperative findings. Conclusion: Preoperative gastrointestinal iodine water imaging in patients with PC can fully understand the gastrointestinal motility and the degree of mesenteric infiltration, guiding clinical screening of appropriate surgical cases.