多层螺旋CT在黑斑息肉综合征诊断中的应用价值
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摘要
目的:探讨多层螺旋CT(MSCT)在黑斑息肉病(P-J)综合征中的应用价值及可行性。方法:回顾性选取29例临床诊断为P-J综合征患者资料,所有患者均行MSCT检查,口服低浓度阳性对比剂后行全腹部CT平扫,部分患者行增强检查。利用CT后处理软件进行三维重建,观察病变位置、形态及与周围组织器官的关系和腹腔内胃肠道外组织器官的情况。同期行肠镜检查或外科手术活检,所有结果均与病理结果进行对照分析。结果:MSCT发现28例患者胃肠道内多发结节,其中11例并发肠套叠;1例患者未见异常。29例患者经病理证实均符合P-J综合征,2例部分息肉为腺瘤样息肉,1例恶变;CT检出率为96.6%(28/29)。29例中CT发现有5例患者合并胃肠道外的肿瘤,3例仅并发卵巢粘液性囊腺瘤,1例同时并发卵巢粘液腺囊腺瘤和乳腺导管内乳头状瘤,1例息肉恶变为腺鳞癌伴肝内及腹腔多发淋巴结转移。结论:MSCT小肠造影是一种简便易行的检查方法,对P-J综合征病灶的定位、定性、鉴别诊断及随访具有较高的应用价值和可行性。
Objective: To investigate the clinical application values and feasibility of reconstruction technique with multi-slice CT(MSCT) in diagnosis of Peutz-Jeghers syndrome. Methods: Twenty-nine patients(men16, women13)with Primary diagnosis of Peutz—Jeghers syndrome were undergone MSCT. All cases experienced abdominal plain scan, the scan range from diaphragm to the pubic symphysis, after oral positive contrast agent. Some of the patients were performed enhanced examination. Images were generated on postprocessing workstation by three-dimensional reconstruction. The position, form of lesions, the relationship with the surrounding tissues and organs, and nongastrointestinal tissues were observed. All cases were undergone endoscopic check or surgical biopsy during the same period. All results were compared with pathological results. Results: 28 cases with multiple nodules in gastrointestinal were found by MSCT, of which 11 cases with intussusception, 1 case was without abnormalities.29 patients confirmed by pathology were accord with PJ syndrome(2 cases with adenomatous polyps, 1 case of malignant transformation), MSCT examination rate was about 96.6%(28/29). 5 of 29 cases had nongastrointestinal tumors: 3 cases of concurrent only ovarian mucinous cystic adenoma, 1 case of concurrent ovarian mucous adenoid cystic adenoma and breast intraductal papilloma, 1 case of polyp progression into gland-squamous cell carcinomas with intrahepatic and abdominal multiple lymph node metastasis. Conclusion: MSCT is a simple and convenient method, and has high application value and feasibility to evaluate lesions position, qualitative, differential diagnosis, follow-up of P-J syndrome.
Objective: To investigate the clinical application values and feasibility of reconstruction technique with multi-slice CT(MSCT) in diagnosis of Peutz-Jeghers syndrome. Methods: Twenty-nine patients(men16, women13)with Primary diagnosis of Peutz—Jeghers syndrome were undergone MSCT. All cases experienced abdominal plain scan, the scan range from diaphragm to the pubic symphysis, after oral positive contrast agent. Some of the patients were performed enhanced examination. Images were generated on postprocessing workstation by three-dimensional reconstruction. The position, form of lesions, the relationship with the surrounding tissues and organs, and nongastrointestinal tissues were observed. All cases were undergone endoscopic check or surgical biopsy during the same period. All results were compared with pathological results. Results: 28 cases with multiple nodules in gastrointestinal were found by MSCT, of which 11 cases with intussusception, 1 case was without abnormalities.29 patients confirmed by pathology were accord with PJ syndrome(2 cases with adenomatous polyps, 1 case of malignant transformation), MSCT examination rate was about 96.6%(28/29). 5 of 29 cases had nongastrointestinal tumors: 3 cases of concurrent only ovarian mucinous cystic adenoma, 1 case of concurrent ovarian mucous adenoid cystic adenoma and breast intraductal papilloma, 1 case of polyp progression into gland-squamous cell carcinomas with intrahepatic and abdominal multiple lymph node metastasis. Conclusion: MSCT is a simple and convenient method, and has high application value and feasibility to evaluate lesions position, qualitative, differential diagnosis, follow-up of P-J syndrome.
引文
[1]李舒丹,金杭斌,张筱凤,等.单气囊小肠镜切除P-J综合征小肠巨大多发息肉3例及文献复习[J].浙江实用医学,2013,18(2):72-74.
[2]刘利波,李有华.Peutz-Jeghers综合征12例诊治分析[J].中国煤炭工业医学杂志,2010,13(1):91.
[3]陈树松,黄厚章,赵家林.Peuti-jeghers综合征的诊治分析[J].中国当代医药,2010,17(28):32-33.
[4]Barker D,Sharma R,Mc Indoe A,et at.An unusual case of sex cord tumor with annular tubules with malignant transformation in a patient with Peutz-Jeghers syndrome[J].Int JGynecol Pathol,2010,29(1):27-32.
[5]王振军,刘玉村,毕郭龙,等.黑斑息肉病病人的恶性肿瘤易感性研究[J].中国实用外科杂志,1999,19(11):655-656.
[6]Giardiello FM,Brensinger JD,Tersmette AC,et al.Very high risk of cancer in familial PeutzJeghers syndrome[J].Gastroenterolgy,2000,119(6):1447-1453.
[7]Gupta A,Postgate AJ,Burling D,et al.Aprospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jeghers syndrome[J].AJRAm J Roentgenol,2010,195(1):108-116.
[8]Maccioni F,Al Ansari N,Mazzamurro F,et al.Surveillance of patients affected by PeutzJeghers syndrome:diagnostic value of MRenterography in prone and supine position[J].Abdom Imaging,2012,37(2):279-287.
[9]王骏,刘小艳.CT扫描技术优化进展[J].中国医学装备,2015,12(2):72-75.
[10]梁宝松,葛英辉,郭滢,等.小肠CT仿真内镜临床应用初探[J].中国医学计算机成像杂志,2003,9(6):267-272.
[11]Mc Garrity TJ,Kulin HE,Zaino RJ.PeutzJeghers syndrome[J].Am J Gastroenterol,2000,95(3):596-604.
[12]Xi Z,Hui Q,Zhong L.Q-switched alexandrite laser treatment of oral labial lentigines in Chinese subjects with Peutz-Jeghers syndrome[J].Dermatol Surg,2009,35(7):1084-1087.
[2]刘利波,李有华.Peutz-Jeghers综合征12例诊治分析[J].中国煤炭工业医学杂志,2010,13(1):91.
[3]陈树松,黄厚章,赵家林.Peuti-jeghers综合征的诊治分析[J].中国当代医药,2010,17(28):32-33.
[4]Barker D,Sharma R,Mc Indoe A,et at.An unusual case of sex cord tumor with annular tubules with malignant transformation in a patient with Peutz-Jeghers syndrome[J].Int JGynecol Pathol,2010,29(1):27-32.
[5]王振军,刘玉村,毕郭龙,等.黑斑息肉病病人的恶性肿瘤易感性研究[J].中国实用外科杂志,1999,19(11):655-656.
[6]Giardiello FM,Brensinger JD,Tersmette AC,et al.Very high risk of cancer in familial PeutzJeghers syndrome[J].Gastroenterolgy,2000,119(6):1447-1453.
[7]Gupta A,Postgate AJ,Burling D,et al.Aprospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jeghers syndrome[J].AJRAm J Roentgenol,2010,195(1):108-116.
[8]Maccioni F,Al Ansari N,Mazzamurro F,et al.Surveillance of patients affected by PeutzJeghers syndrome:diagnostic value of MRenterography in prone and supine position[J].Abdom Imaging,2012,37(2):279-287.
[9]王骏,刘小艳.CT扫描技术优化进展[J].中国医学装备,2015,12(2):72-75.
[10]梁宝松,葛英辉,郭滢,等.小肠CT仿真内镜临床应用初探[J].中国医学计算机成像杂志,2003,9(6):267-272.
[11]Mc Garrity TJ,Kulin HE,Zaino RJ.PeutzJeghers syndrome[J].Am J Gastroenterol,2000,95(3):596-604.
[12]Xi Z,Hui Q,Zhong L.Q-switched alexandrite laser treatment of oral labial lentigines in Chinese subjects with Peutz-Jeghers syndrome[J].Dermatol Surg,2009,35(7):1084-1087.