急性重症小儿肠套叠的彩色多普勒超声与手术病理对照研究

The Study of Acute Severe Pediatric Intussusception by Color Doppler Ultrasonography and Pathology

目的:研究彩色多普勒超声对急性重症小儿肠套叠的定位、定性诊断的临床意义。材料与方法:急性重症肠套叠的患儿89例,所有患儿直接具手术指征或X线下空气灌肠复位失败后进行肠套叠手术治疗,其中单纯行肠套叠松解术患儿70例,肠套叠松解术并部分肠管切除19例;所有患儿术前常规行腹部彩色多普勒超声检查。以手术病理为对照,系统研究普通二维超声对肠套叠的定位诊断及彩色多普勒超声对急性重症小儿套叠肠管壁血供情况的定性诊断能力及缺血肠管长度测量。结果:普通二维超声对肠套叠的定位诊断及彩色多普勒超声对急性重症小儿套叠肠管壁血供情况的定性诊断与手术病理的差异无显著性统计学意义(P>0.05);彩色多普勒超声共诊断肠套叠并肠管缺血的假阳性率为17.4%;彩色多普勒超声测量缺血肠管长度与手术病理结果的差异具有显著性统计学意义,但两者结果相关分析提示两者测量长度呈正相关(γ=0.625)。结论:彩色多普勒超声对肠套叠并肠管缺血坏死的诊断及累及肠管长度的测量有一定指导意义,但存在一定比例的假阳性。因此,肠套叠的诊断必须强调影像学结合临床,不宜单纯依赖超声检查结果而贸然选择治疗方案。

Purpose： To study the localization and qualitative diagnosis of acute severe pediatric intussusception by color Doppler Ultrasonography. Materials and Methods： Children with acute severe pediatric intussusception （ n = 89） were treated by surgical methods, including intussusception debonding （n = 70） and with removal of part colon （n = 19）. All of the cases were study with color Doppler Ultrasonography and the length of ischemia intestines were measured compared with operation/pathology. Results： The localization and qualitative diagnosis of acute severe pediatric intussusception between color Doppler Uhrasonography and operation/pathology have no significa~ statistical differences （ P 〉 0. 05 ）. The false positive incidence of diagnosis of ischemia intestines by color Doppler Ultrasouography was 17. 4%. The length of isehemia intestines were measured by color Doppler Ultrasonography and operation/pathology have significant statistical differences （ P 〈 0. 05 ） but positve corrclation（ γ = 0. 625 ）. Conclusion： The isehemia intestines of acute severe pedialric intussusception could be show and measured by color Doppler Uhrasonography, but false positives were found in some cases. The diagnosis of intussusception may closely associate with clinical and lab data, and be differentiated with other pediatric acute abdomen.