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小腸灌腸檢查的技術、價値、與臨床應用－100次檢查的經驗
Small Bowel Enema-Experiences in 100 Cases
摘要
小腸是消化道中最難診斷的部份，文獻上多位作者建議以小腸灌腸檢查(small bowel enema)改善診斷。小腸灌腸檢查的適應症、檢查技術、以及使用頻率，各醫院間差異仍大，有待進一步的評估。本文複閱三軍總醫院近三年來100次小腸灌腸檢查的結果加以分析比較。我們以Herlinger氏方法爲準並略加改良來做檢查。經直腸充氣可以有效的改善深陷骨盆腔內迴腸的檢查品質。在同時做過傳統小腸追踪檢查與灌腸檢查的17例之中，有4例(24%)病灶僅見於灌腸檢查，6例(35%)顯示灌腸檢查品質較佳且能提供更具診斷價値的訊息。6例(35%)顯示兩種檢查旗鼓相當，對病灶的偵測力無顯着差異。17例中共計有10例(59%)可因灌腸檢查而獲益。35例後來接受手術並獲得確定的診斷，其中31例(89%)診斷完全正確。若臨床強烈懷疑小腸病變，即使追踪檢查完全正常，亦應實施灌腸檢查。小腸單一、局部性病灶、懷疑腸道間或腸道與器官間有瘻管、小腸阻塞、腸蠕動異常或腸液分泌過多，應優先選擇小腸灌腸檢查。灌腸檢查對多發、瀰散性病灶的診斷價値較差，且不易鑑別腹膜癌病或黏連束帶造成的小腸阻塞。在具有迴腸造口的病人，前行性灌腸檢查要比逆行性灌腸檢查更有效的診斷造口附近的小腸病變。
並列摘要
As small intestine is the most difficult part of gastrointestinal tract to evaluate, some authors have suggested small bowel enema to improve diagnosis. However, indication, techinque and frquency of this enema present wide differences and need further evaluation. In this study, the radiological findings of 100 consecutive cases having small bowel enema by use of a modification of Herlinger's method were reviewed. Transrectal pneumocoln was found to be helpful in imporving diagnosis of deeply located ileum in pelvis. Comparison was made between conventional small bowel follow-through and small bowel enema in 17 patients. Four lesions (24%) were detected by small bowel enema only. Six lesions (35%) were better diagnosed by small bowel enema. Six (35%) appeared little difference, whether by enema or follow-through. Overall, 10 (59%) were supposed to benefit from small bowel enema. Thirty-five patients underwent laparotomy later to prove 31 of them (89%) to be correctly diagnosed. Small bowel enema should be considered in patients clinically strongly suggestive of small bowel disease when all the other studies were negative in result. It is also of choice for single focal lesion, fistula between bowel and organs, intestinal obstruction, motility disorders or hypersecretion. Yet, it is less advantageous or contributory in multifocal or diffuse small bowel lesions, and is difficult to differentiate seeded malignant intestine obstruction from benign adhesion. Antegrade approach is more effective in evaluating paraileostomy lesions than retrograde approach in patients with ileostomy.