团队的力量 Strength of our team
Strength of our team！！
湘雅医院2008级五年制临床医学、麻醉医学及口腔七年制18组同学合作完成本文的翻译
Double-Contrast Upper Gastrointestinal Radiography: A Pattern Approach for Dias of the Stomach
Abstract
The double-contrast upper gastrointestinal ries is a valuable diagnostic test for evaluating structural and functional abnormalities of the stomach. This article will review the normal radiographic anatomy of the stomach. The principles of analyzing double-contrast images will be discusd. A pattern approach for the diagnosis of gastric abnormalities will also be prented, focusing on abnormal mucosal patterns, depresd lesions, protruded lesions, thickened folds, and gastric narrowing.
This article prents a pattern approach for the diagnosis of dias of the stomach at double-contrast upper gastrointestinal radiography. After describing the normal appearance of the stomach on double-contrast barium studies and the principles of
double-contrast image interpretation, we will consider abnormal surface patterns of the mucosa, depresd lesions (erosions and ulcers), protruded lesions (polyps, submucosal mass, and other tumors), thickened folds, and gastric narrowing.
上消化道双重对比造影：
上消化道双重对比造影：一种用于
一种用于胃部疾病诊断的成像方法
摘要
上消化道双重对比造影系列是用于评估胃部结构性和功能性病变的一种极有价值的诊断方法。本文将回顾胃部正常解剖的影像学表现，探讨双重对比造影图像分析的原则。文中还介绍了一种胃部病变的诊断方法，
中还介绍了一种胃部病变的诊断方法，该法侧
该法侧重于观察异常的黏膜形状，凹陷性的病变、突出性的病变、增厚的黏膜皱襞和消化道的狭
窄。
本文阐述了一种通过上消化道双重对比造影诊断胃部疾病的方法。在描述双重对比造影中胃的正常表现和双重对比造影图像分析原则后，我们将关注胃粘膜表面的异常形态，凹陷性的病变（糜烂和溃疡）、突出性的病变（息肉、黏膜下的块状物和其他肿块）、增厚的黏膜皱襞和消化道狭窄。
NORMAL STOMACH
Gastric Configuration and Rugal Folds
The normal stomach is a J-shaped pouch
that lies in the left upper quadrant (Fig 1). The stomach has a fixed configuration created by the greater
length of the longitudinal muscle layer
on its greater curvature. The lesr
curvature of the stomach is suspended from the retroperitoneum by the hepatogastric ligament, a portion of the
lesr omentum. The gastrosplenic
ligament and gastrocolic ligament (ie,
西湖三堤the proximal portion of the greater omentum) are attached to the greater curvature of the stomach. The gastric cardia is attached to the diaphragm by the surrounding phrenoesophageal membrane.
Figure 1:
Normal stomach. Double-contrast spot image of stomach with patient supine shows distal gastric body (B) and antrum (A). Greater curvature (white arrows) and lesr curvature (black arrows) are coated by barium. Rugal fold on posterior wall of gastric body is depicted as tubular, slightly undulating, radiolucent filling defect (black arrowheads) in shallow barium pool. Den barium pool outlines contour (white arrowheads) of gastric fundus 正常胃
胃的外形与皱襞
正常的胃位于左上腹，
正常的胃位于左上腹，形似
形似J型嚢袋（图）
多哈时间1），
，胃固定的形态是由胃大弯上较长的纵向肌层形成的。胃小弯通过小网膜的一部分--肝胃韧带悬挂在腹膜后腔内。胃脾韧带和胃结肠韧带（即大网膜近端）连于胃大弯上。胃贲门通过其周围的隔食管膜连于隔上。
图1：
正常胃：病人取仰卧位进行双重对比造影可以显示远端的胃体（B）和胃窦（A）。胃大弯（白色箭头所示）和胃小弯（黑色箭头所示）均覆盖有一层钡剂。射线透过钡池较浅的胃体部，能显示出胃体后壁的粘膜皱襞，呈管状、细小的波浪形的充盈缺损。胃底部（F）钡池稠密，勾勒出胃底的轮廓（白色小箭头所示）。胃底的粘膜表面和皱襞被稠密的钡池掩盖而不易看见，胃窦部无皱襞。
电音歌曲(F). Mucosal surface and folds in fundus are obscured by barium pool, and antrum is devoid of rugal folds.
cardiac “rotte” (Fig 2) (1,2).
The gastric fundus is defined as the portion of the stomach craniad to the gastric cardia. The gastric body is defined as the portion of the stomach extending from the gastric cardia to the smooth bend i
n the mid lesr curvature known as the incisura angularis. The gastric antrum is defined as the portion of the stomach extending from the incisura angularis to the pylorus (a structure created by a muscle sphincter shaped like a figure eight).
Figure 2:烧咸鱼
Double-contrast spot image of gastric fundus with patient in right-side-down position shows normal gastric cardia with smooth folds radiating to central point (white arrow) at clod gastroesophageal junction, also known as cardiac rotte. Long, straight fold (arrowheads) extends inferiorly from cardia along lesr curvature. Black arrows denote normal extrinsic impression by adjacent spleen.
Rugal folds are most prominent in the gastric fundus and body, whereas the gastric antrum is often devoid of folds (Fig 1). Gastric rugae are changeable
贲门“玫瑰花形”（图2）（1,2）
胃底是指胃贲门入口水平线以上的部分。
胃底是指胃贲门入口水平线以上的部分。胃小
胃小弯中断转弯处称为角切迹，胃自贲门至角切迹的部分称为胃体。胃窦指从角切迹至胃幽门（一个由括约肌组成的“8”字形结构）的部分。盒子怎么做
图2
在病人的仰卧水平右侧位胃底的双对比造影点片上，可观察到正常的胃贲门有很多光滑的皱襞，这些皱襞呈放射性的指向（大白箭头）中间胃食管连接部即贲门瓣的位置。小白箭头指的是直接从贲门延伸到胃小弯的纵行皱襞，黑箭头则为邻近的脾压迫胃所产生的压迹。
胃皱襞大部分突起于胃底和胃体，
胃皱襞大部分突起于胃底和胃体，胃窦通
胃窦通常是没有皱襞的（图1）。胃皱襞由粘膜层和粘膜下层组成（3,4），这些皱襞在胃小弯部比较直，在胃大弯部则呈波浪形。胃皱襞的厚
structures compod of mucosa and submucosa (submucosa (33,4). The rugal folds are relatively straight on the lesr curvature of the stomach but larger and more
undulating on the greater curvature. The thickness of the rugal folds varies with the degree of gastric distention (the degree of gastric distention (55).
纳米和米的换算
Areae Gastricae
The mucosal surface of the stomach consists of flat polygonal-shaped tufts of mucosa, known as areae gastricae, parated by narrow grooves (parated by narrow grooves (66,7). The areae gastricae are recognized on double-contrast studies as a reticular network of barium-coated white lines when barium fills the grooves between the mucosal tufts (the mucosal tufts (Fig 3Fig 3). Individual mucosal tufts of areae gastricae
normally have a diameter of 2–3 mm in the gastric antrum and of 3–5 mm in the gastric body and fundus (gastric body and fundus (Fig 3Fig 3) () (66,8). Areae gastricae are detected on
double-contrast studies in nearly 70% of patients and are obrved with greater frequency in the elderly (frequency in the elderly (88,9).
Figure 3:
Double-contrast spot image of stomach with patient in left posterior oblique position shows normal areae gastricae pattern in antrum as 2–3-mm
polygonally shaped radiolucent tufts of mucosa outlined by barium in grooves.
蝴蝶落叶
度随胃膨胀的程度而变化（5）。
胃区
胃黏膜表面由扁平多边形黏膜丛构成，胃黏膜表面由扁平多边形黏膜丛构成，称称为胃区，它被狭窄的凹槽分隔（6,7）。在双对比造影研究中，钡剂填充在黏膜丛的凹槽中，胃区为由钡剂覆盖的白色线条交错构成的复杂网状结构（图3）。机体胃区黏膜丛直径在胃窦部一般为2至3厘米，在胃体和胃底部为3至5厘米（图3）（6，8）。在近70%的病人中，胃区能通过双对比相研究观察到，而对于老年人，能被观察到的概率则更大（8,9）。
图3
在病人左后斜位胃的双对比造影点片上可观察到胃窦部正常的胃区图像，即长为2至3厘米，多边形、射线可穿透的黏膜丛，由钡剂显示其轮廓。胃体尾部的胃小区比胃窦部稍微大些。
Areae gastricae are slightly larger in distal gastric body than in antrum.
Comparison of Histologic Anatomy with Macroscopic Anatomy A basic understanding of the histologic anatomy of the stomach is helpful for understanding peptic ulcer dia, as well as other gastric abnormalities (5,10). The stomach contains veral types of mucosa: cardiac-type mucosa, b
吃西餐的顺序ody/fundic-type mucosa, and antral/pyloric-type mucosa. Gastric foveolae (or pits) are conical
depressions in the mucosal surface that
communicate with gastric glands (communicate with gastric glands (44,10). The glands are long, straight, and tightly
packed structures. The foveolae in all parts of the stomach are lined by surface foveolar mucous cells. The cardiac-type mucosa compris a short (1 cm in length) gment of the gastric mucosa adjacent to the gastroesophageal junction (junction (44). The distinguishing feature of the body-type mucosa is the prence of parietal and chief cells in the glands. The parietal cells produce hydrochloric acid and intrinsic factor, and the chief cells produce proteolytic enzymes. No parietal or chief cells are found in antral-type mucosa. The surface foveolar mucous cells line both antral pits and glands.
Body-type mucosa lines the anatomic gastric fundus and the gastric body and extends into the gastric antrum along the greater curvature (greater curvature (44). Antral-type
mucosa lines the antrum along the lesr curvature from the pylorus to the
incisura angularis, but only lines a small amount of antrum along the greater
组织学与宏观解剖学的比较
对胃组织学结构有一个基本的学习有助于我们更好的理解消化性溃疡及其它胃功能紊乱性疾病（5，10）。胃包括几种不同类型的黏膜：贲门型黏膜、胃体/胃底型黏膜，以及幽门/胃窦型黏膜。胃黏膜表面有些圆锥形的凹陷，叫做胃小凹（胃小点），它与胃腺相沟通（4,10）。腺体形直体长，且为严密包裹的结
构。在胃的各个部分，胃小凹均由表层小凹黏膜细胞连接而成。贲门型黏膜由一个邻近胃食管连接部只有1厘米长的胃黏膜小段构成（4）。胃体型黏膜最明显的特征是其胃腺中有壁细胞和主细胞。壁细胞分泌盐酸和内因子，主细胞分泌蛋白水解酶。胃窦型黏膜中无
壁细胞和主细胞。胃窦胃小凹和胃腺由胃小凹黏膜细胞相连。
胃体型黏膜移行贯穿于解剖学上的胃底和胃体，并沿着胃大弯延伸至胃窦部。胃窦型黏膜则沿着胃小弯从幽门到角切迹移行贯穿于整个胃窦部，但在胃大弯处只移行一小部分。所以，组织学上分型把胃分为体型及窦型黏膜，和解剖学上及放射学上把胃分为底部、体部、窦部是没有相关性的。
