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近年来由于X线诊断技术的进步和普及,胃的微细病变诊断能力有了明显提高。利用充盈法、双重造影法(下称双重法)和压迫法进行组合,可以把直径10mm,高度1mm的微小胃粘膜病变显示出来,使早期胃癌的检出日益增多。但目前进行期胃癌的X线诊断,漏诊误诊情况仍占一定比例。我院自1980年1月至1984年6月手术切除的胃癌161例,漏诊7例,漏诊率4.3%。误诊4例,误诊率2.4%。漏诊的原因有:不按常规检查组合进行,省去三大检查法中的1～2个,依赖透视;X线漏检某些部位,如胃上部、幽门前区,共5例。不认征2例(癌浸润浅肌层)。有2例并发多量空腹胃贮留液。误诊例全部发生在溃疡形成性胃癌与良性溃疡的鉴别诊断上。现就如何提高X线正确诊断率,讨论三个问题。
In recent years, due to the advancement and popularization of X-ray diagnosis technology, the ability to diagnose the microscopic lesions of the stomach has been significantly improved. By combining the filling method, double contrast method (hereinafter referred to as the double method) and the compression method, the small gastric mucosal lesions with a diameter of 10 mm and a height of 1 mm can be displayed, and the detection of early gastric cancers is increasing. However, the current X-ray diagnosis of gastric cancer, misdiagnosis and misdiagnosis still account for a certain percentage. In our hospital from January 1980 to June 1984, 161 cases of gastric cancer were resected and 7 cases were missed. The rate of missed diagnosis was 4.3%. Misdiagnosis occurred in 4 cases and misdiagnosis rate was 2.4%. The reasons for missed diagnosis are: do not follow the routine examination combination, save 1 to 2 of the three major inspection methods, rely on perspective; X-ray missed certain parts, such as upper stomach, pre-pyloric area, a total of 5 cases. Two patients were not admitted (infiltrative superficial muscularis). There were two cases of fasting stomach retention fluid. Misdiagnosis cases all occurred in the differential diagnosis of ulcerative gastric cancer and benign ulcers. Now on how to improve the correct diagnostic rate of X-rays, discuss three issues.