核素显像对小儿小肠出血的临床意义

目的探讨放射性核素显像对小儿小肠出血定位及病因诊断的价值。方法回顾性分析本科经手术及病理明确病因的31例小肠出血患儿的临床资料。31例术前均经胃镜及肠镜检查未能明确病因而行核素显像检查。先行99mTcO-4显像,阴性者再行99mTc-RBC显像,腹部出现异常放射性核素浓聚为阳性。结果31例小肠出血患儿Meckel憩室15例(占48.39%)、小肠重复畸形7例(占22.58%)。31例患儿99mTcO4-显像阳性17例,其中病理发现异常胃黏膜16例;99mTcO4-阴性14例,99mTC-RBC显像阳性9例,其中4例Meckel中有1例病理发现异常胃黏膜。1例Meckcl憩室99mTcO4-显像对异位胃黏膜诊断的灵敏度、特异性分别为93.75%、86.67%,阳性结果时预期值71.43%;99mTcO4-显像对儿童小肠出血的检出率为54.84%,联合99mTc-RBC显像后检出率增至83.87%。结论核素显像对小儿小肠出血的定位、定性有重要的指导意义。

Objective To evaluate the clinical value of radionuclide imaging in children with small intestinal bleeding. Methods 31 cases of small intestinal bleeding were retrospective analyzed, which were identified by operations and pathology. Before operations,^99mTcO4^- abdomen dynamic imaging were performed on all patients, those had negativity results underwent farther ^99mTc - RBC imaging. Results 15 of 31 （48.39%）with positivity result cases in ^99mTcO4^- imaging were found having Meckel diverticulum; 7（22.58% ）were found duplication of intestine. 17 out of 31 of the patients were positive in ^99mTcO4^- imaging , 16 of whom were found having ectopic stomach musoca in pathology examination , the other 14 were negative in ^99mTcO4^- imaging . 9 cases were positive in ^99mTc- RBC imaging , among 4 of whom with Mekel diverticulum , there was 1 case in which abnormal stomach musoca was found according to pathology examination . The sensitivity and specificity of radio nuclide ^99mTcO4^-imaging to ectopic stomach museca were 93.75% and 86.67%, respectively, the expectation value was 71.4 % when radio nuclide imaging were positive ;when combined with ^99mTc - RBC imaging, the detecting rate improved from 54. 84% to 83.87 %, compared with using ^99mTcO4^- imaging alone . Conclusion radionudide image is a noninvasive and reliable detective method in diagnosis of intestinal bleeding in children.