小儿肠套叠合并肠坏死的超声表现及诊断价值

Ultrasonographic findings of intussusception complicated by intestinal necrosis in children

目的肠套叠合并肠坏死是空气灌肠复位的绝对禁忌症，目前对小儿肠套叠合并肠坏死的超声检查表现及特点报道较少，该研究重点探讨其超声表现，及时指导临床医生正确选择复位方式。方法回顾性分析2004—2006年手术复位的48例肠套叠合并肠坏死病例的超声图文资料。结果①肠套叠的类型与肠坏死密切相关，回回结型最易导致肠坏死；②套叠部肠壁明显增厚，套叠中心部常伴有肿大的淋巴结、肿大的阑尾；③肠套叠内积液、套叠远端肠管扩张伴肠壁增厚、肠蠕动减弱或消失是肠壁大片坏死的表现；④继发性肠套叠也是导致肠坏死的一个重要因素，部分可探及原发病灶的声像；⑤腹腔积液是所有肠套叠伴肠坏死的共同表现。结论当肠套叠伴肠坏死时有一些较为明显的声像图特征，可间接提示肠坏死的可能，掌握这些超声表现能及时指导临床医生正确选择复位方式。

Objective The information on the uhrasonographic features of pediatric intussusception complicated by intestinal necrosis is limited at present. This study aimed to investigate the uhrasonographic findings of this disorder in children in order to provide references for selecting a right means of reduction in clinical practice. Methods The uhrasonographic findings of 48 children with intussusception complicated by intestinal necrosis and who underwent operative reduction between 2004 and 2006 were reviewed retrospectively. Results The type of intussusception was closely correlated to the development of intestinal necrosis and the ileo-ileo-colonic intussusception was the most common one resulting in intestinal necrosis. The bowel wall of the invaginated segment was obviously thickened and the center of the invaginated segment was often accompanied with swollen lymph node and appendix caecalis. The intussusceptional fluidify, the expanding of distal segment accompanied with the thickened bowels wall, and weakening or disappearance of enterokinesia were the appearances of necrosis of most of bowel walls. The secondary intussusception was an important factor resulting in intestinal necrosis, and sound image of primary lesion was found in some patients. Seroperitoneum was a common manifestation in all of infants with intussusception complicated by intestinal necrosis. Conclusions There are some obvious sonographic characteristics of intussusception complicated by intestinal necrosis in children. The means of intussusception reduction may be selected according to ultrasonographic characteristics.