肠套叠超声表现与病理、可复性、缺血的相关研究

Sonographic patterns of intussusception with relationship to pathologic change,reducibility and ischemia

目的 探讨超声检查肠套叠与病理、灌肠可复性、肠管缺血的相关性及其价值。方法 2 1只兔通过外科手术产生肠套叠 ,活体上进行超声扫查并与病理改变相比较。回顾性分析经手术或空气灌肠证实的 2 5例儿童肠套叠的声像图结果。结果 动物实验结果表明 :①在没有明显肠壁血供障碍的情况下 ,横断扫查肠套叠声像图表现为强回声和低回声相间排列的“同心圆”或“靶环”征 ,在肠管发生缺血时 ,超声表现为“炸面圈”征。②肠管的生机、肠套叠的灌肠治疗可复性与肠套叠“炸面圈”征外圈低回声厚度、肠套叠间的彩色血流有明显的相关性。肠套叠间未测及彩色血流时 ,其肠壁坏死的可能性明显增加 (P <0 .0 1)。“炸面圈”征外圈低回声越厚 ,肠套叠部肠管缺血就越明显。儿童肠套叠声像图结果 :①当低回声厚度 >9mm时 ,其空气灌肠的可复性明显降低 (P <0 .0 1) ;②当低回声厚度≥ 12mm时 ,发生肠管坏死的可能性明显增高 (P <0 .0 5 )。结论 超声检查结合彩色多普勒血流显像对于预测肠套叠灌肠可复性或肠管生机是一种有用的诊断方法。

Objective To investigate sonographic patterns of intussusception with relationship to pathologic change,reducibility and ischemia. Methods Twenty-one intussusceptions were surgically induced in rabbits,and in vitro ultrasonography was compared with the corresponding pathologic changes. Ultrasonography findings in 25 cases of pediatric intussusception confirmed by means of air enema examination or surgery were analyzed. Results The results of animal experiment showed that:①when no ischemia of intestine loop occurred,axial images of intussusception showed a 'target-like' mass,if ischmia of intestine loop appeared,it demonstrated as a 'doughnut-like' mass; ②bowel unviability and reducibility seemed clearly related to the thickness of hypoechoic external rim of the 'doughnut' mass and blood flow on color Doppler flow images (CDFI) in intussusceptum. When the flow on CDFI in intussusception was absent,the possibility of bowel necrosis was increased( P < 0.01 ). The thicker hypoechoic external rim of the 'doughnut' mass was,the more evident ischemia of intussusception was. Clinical applications showed that:① when the thickness of hypoechoic external rim was more than 9 mm,the reduction rate of enema was clearly decreased( P < 0.01 ); ②when the thickness was equal to,or more than 12 mm,the possibility of bowel necrosis was increased( P < 0.05 ). Conclusions Sonography combined CDFI is a useful diagnostic method for predicting bowel unviability and reducibility of intussusception.