B超测定幽门容积对肥厚性幽门狭窄的诊断价值

The sonographic evaluation of the pyloric volume in the diagnosis of hypertrophic pyloric stenosis

目的探讨幽门容积(pyloric volume,PV)对肥厚性幽门狭窄(hypertrophic pyloric stenosis,HPS)的诊断价值.方法在本研究中应用B超测量了30例HPS患儿和50例正常婴幼儿的幽门管长度(pyloric length,PL)、直径(pyloric diameter,PD)和幽门部肌层厚度(muscular thickness,MT),计算出幽门容积.同时,对胃蠕动、胃排空、幽门开放及胃内容物通过情况等胃功能方面作比较研究.结果30例HPS患儿和50例正常婴幼儿,上述四项幽门指标测值统计学差异有显著性意义(P<0.001),但PL、PD及MT等三项指标在正常婴幼儿上限值和HPS患儿下限值表现出重叠,重叠范围为:PL,1.5～1.7 cm;PD,1.0～1.3 cm;MT,0.3 cm;而PV是唯一没有重叠的指标:正常婴幼儿范围0.28～1.3ml,HPS患儿范围1.40～7.93ml.同时,观察到30例HPS患儿,幽门持续性关闭,胃内容物通过幽门管受阻,胃扩张及逆蠕动.50例正常婴幼儿幽门有节律的开放,胃内容物通过顺利,胃排空较快.结论若PV≥1.4ml,未见幽门松弛及胃内容物通过幽门管,则应作为HPS看待和治疗.

Objective To investigate the diagnostic values of pyloric volume (PV) inferred from B ultrasound examination for hypertrophic pyloric stenosis (HPS).Methods In the current study, values of pyloric length (PL), pyloric diameter (PD), and muscular thickness (MT) were gained through B ultrasound examination in HPS(n=30) and normal infants (n=50). PV values were then calculated from PL, PD and MT. The peristalsis and emptying of the stomach and opening and fluid passage of the pylorus were recorded in all cases.Results The significant differences of all these 4 indexes were noted between HPS and normal group. There was overlap between HPS and normal group in term of PL, PD, and MT. No overlap in PV, however, was found between normal infant ( 0.28ml～ 1.3ml) and patients with HPS ( 1.4ml～ 7.93ml). No gastric contents passed through pyloric channel in all patients with HPS. Meanwhile, the retrograde peristaltic waves were always presented in HPS cases. In all 50 normal infants, on the other hand, gastric contents passage through pylorus with regular gastric peristaltic waves was observed.Conclusions PV value inferred from B ultrasound examination deserves a reliable index for diagnosis of HPS.