高频超声与X线钡剂造影对先天性肥厚性幽门狭窄诊断及分型的价值

The application value of high-frequency ultrasound and X-ray barium meal examination in diagnosis and subtype diagnosis of congenital hypertrophic pyioric stenosis

目的探讨高频超声与X线钡剂造影对先天性肥厚性幽门狭窄（CHPS）诊断与分型诊断的价值。方法对以呕吐为主要症状的患儿常规进行高频超声和X线钡剂造影检查，并将两种检查方法加以对照。对经手术证实、资料完整的29例病例进行回顾性分析。正常组选取健康新生儿20例，并对其正常测值与CHPS组进行对比。结果29例CHPS，超声诊断符合率100％，X线诊断符合率93．1％（27／29）。CHPS组超声测量幽门管的长度均≥18mm，幽门管直径≥14mm，幽门管壁厚度≥4mm，狭窄的管腔径均≤6mm；X线测量幽门管长≥20mm，管腔径≤7mm，与正常组比较差异均有统计学意义（P〈0．01）。根据幽门管腔狭窄和管壁增厚程度的影像表现，将CHPS分为轻型（Ⅰ）和重型（Ⅱ）两类，若4mm≤幽门管壁厚≤6mm，幽门管腔径〉3mm为轻型；幽门管壁厚〉6mm，幽门管腔径≤3mm或呈闭塞状为重型。结论CHPS的超声分型诊断具有一定的临床价值；高频超声对CHPS的诊断简便易行、准确可靠，避免了患儿吞钡和X线照射及减少吸入性肺炎的危险。

Objective To evaluate the value of high-frequency ultrasound and X ray barium meal examination in diagnosis and typing diagnosis of congenital hypertrophic pyloric stenosis（CHPS）. Methods High frequency ultrasound and X ray barium meal examination were made in newborns with present symptom of vomiting,and comparison was made between the two examine methods. Retrospective analysis was made in 29 cases confirmed by surgical operation. Control normal group included twenty healthy newborns. Results In 29 CHPS cases, the diagnostic accordance rate of ultrasound was 100%. And the diagnostic accordance rate of X-ray barium meal examination was 93.1% （27/29）. In all those CHPS cases, the length of pylorie canal were ≥18 mm,the diameter of pyloric canal were≥14 mm,tbe wail thickness of pyioric canal were ≥4 mm, the stenosis inside diameter were46 mm by ultrasound;in X ray barium meal examination,the length of pyloric canal were ≥20 mm, the inside diameter were ≥7 mm, and there was significant difference in comparison with control group （ P 〈0. 01）. The CHPS was classified into two groups as mild stenosis and severe stenosis according to the inside diameter and the wall thickness of pyloric canal. The mild type showed the wail thickness was 〉4 mm and 46 mm,the inside diameter was 3 mm; The severe type showed the wail thickness was 〉6 mm, the inside diameter was 43 mm or obliterate. Conclusions High -frequency ultrasound has significant clinical application value in diagnosis and subtype diagnosis of CHPS,it is an easy, reliable and safe examination method.