儿童肠系膜囊肿及继发病变超声表现

Ultrasonic features of pediatric mesenteric cysts and their complications

目的总结儿童肠系膜囊肿及继发病变超声表现,评价超声诊断儿童肠系膜囊肿及继发病变的价值。方法对2005年1月至2010年12月我院收治的经手术及病理证实的41例肠系膜囊肿患儿超声表现和手术所见进行对比分析。结果本组41例肠系膜囊肿患儿共42个病灶,其中单发40例,多发1例。42个肠系膜囊肿病灶中,超声呈单房囊性(4个)或多房囊性(37个)包块;肠系膜囊肿超声声像图表现为形态规则的单房囊性团块或边缘不规则、囊腔大小不一、形态不一的多房囊性团块,囊内回声因成分不同而不同。本组8例肠系膜囊肿患儿继发出血,超声检查示出血囊腔张力增高、透声减低;6例患儿肠系膜囊肿及肠扭转并肠梗阻,超声检查可见肠管积液扩张及扭转肠系膜的"集束征"或"漩涡征";4例患儿继发感染,超声检查示囊肿壁增厚、周围见低回声索条。本组41例肠系膜囊肿患儿42个病灶术前超声诊断正确39个,超声诊断符合率92.9%(39/42),术前超声误诊3个,分别误诊为大网膜囊肿1个、肠重复畸形1个、肠系膜淋巴血管瘤1个;本组肠系膜囊肿合并症诊断符合率为66.7%(12/18),术前超声漏诊6例,分别为出血3例、肠梗阻1例、感染2例。结论超声检查对儿童肠系膜囊肿可作出定性诊断,对其并发症诊断也有很高的价值。超声检查应作为儿童肠系膜囊肿首选影像学检查方法 。

Objective To summarize the ultrasonic features of pediatric mesenteric cysts and their complications and evaluate the value of ultrasonography in diagnosing pediatric mesenteric cysts.Methods The clinical data of 41 pediatric mesenteric cysts confirmed by histology between 2005 and 2010 were reviewed retrospectively.The features of ultrasound and surgical operation were compared respectively.Results Forty-two lesions were identified in 41 cases,including solitary lesions in 40 cases and multiple lesions in one case.In ultrasonography,pediatric mesenteric cysts appeared as multilocular cystic masses（37 cases）or unilocular cystic masses（4 cases）,single cavity mass with regular shape or multi-cavity mass with irregular edges and various shapes and sizes.The echoic characteristic inside the cavity depends on different components in the cavity.The complications of pediatric mesenteric cysts include secondary hemorrhage（8 cases）appeared as increased tension and echogenicity of cysts,intestinal obstruction and volvulus（6 cases）appeared as expanded enteric cavity and typical signs of mesentery torsion ie.＂the convergence sign＂and＂the whirlpool sign＂and infection（4 cases）showed as thickened cyst wall and hypoechgenic strips around.Thirty-nine of 42 lesions were correctly diagnosed by ultrasonography before surgery.The ratio of correct diagnosis was 92.6%.Three had been misdiagnosed as cyst of the greater omentum（1 case）,intestinal duplication（1 case）and mesenteric lymphangioma（1 case）.The ratio of correct diagnosis of the complications of mesenteric cysts was 66.7%（12/18）.Six cases were missed by ultrasonography,including 3 cases of hemorrhage,2 cases of infection and 1 case of intestinal obstruction.Conclusion Ultrasonography is a valuable and reliable tool in diagnosing pediatric mesenteric cysts and complications.