His角与小儿胃食管反流的关系及其超声诊断价值

The relationship of His angle and gastro esophageal reflux in children and its diagnostic value of ultrasound

目的探讨His角与小儿胃食管反流(GER)的关系及其超声诊断价值。方法应用彩超分别对GER(病变组)和正常(对照组)小儿各60例在胃充盈状态下观察胃食管连接区形态结构、GER现象并测量食管胃角(His角),所测数据与临床症状比较,分析患儿胃食管连接区解剖结构异常与GER的关系。结果超声对胃食管连接区解剖结构切面显示清晰,His角的显示率为100%。GER典型声像图表现为腹段食管局限性膨大,形似喇叭口状,管腔内见杂乱强回声来回运动,如遇返流发作时则见胃内容物涌入食管。2组小儿His角均随年龄增长而逐渐变小,但病变组各年龄段His角度平均高于对照组7.4°(P<0.05);病变组各年龄段His分别是5 d～1岁96.3°、1～岁92.6°、3～岁87.4°、6～岁84.5°、9～12岁81.2°,GER各年龄段His角度比较差异有统计学意义(P<0.05)。对返流阳性率比较其敏感度为95.0%,特异度为78.3%。结论彩超对小儿胃食管连接区探查及其解剖结构正常与否的判断对GER诊断有重要临床意义,对于有高度怀疑GERD的患儿,His角超声检测可作为GER最便捷首选的筛查手段。

Objective To explore the relationship of the His angle and children with gastro esophageal reflux（GER） and the diagnostic value of ultrasonic.Methods Color Doppler ultrasound was used to observe GER in GER（lesion group） and normal（control group） in children,60 children with gastro esophageal connection area morphology observed in the gastric filling state of GER phenomenon and measured the His angle,the measured data and clinical symptoms,analyzed the stomach and esophagus connected to the anatomical relationship with GER.Results Ultrasound on the anatomic structure of gastro esophageal connection section display clear images typical of GER,the His angle was 100%,GER typical sonographic was abdominal esophagus limitations of enlargement,the shape of a bell-shaped,and clutter strong echo back and forth movement in the lumen,the influx of stomach contents in case of reflux episodes esophageal.Two groups of children His angle size with age,it becomes weak,but His angle lesions of all ages average higher in the more than 7.4 degrees.There was significant difference between the two groups（P 0.05）;The His angle of lesions all age＇s： 5D-1-year-old 96.3 degrees,1-3 years 92.6 degrees,3-6 years 87.4 degrees,6-9 years 84.5 degrees,9-12 years 81.2 degrees.GER of all ages His angle difference was also statistically significant（P 0.05）.GER of all ages His angle difference was also statistically significant（P 0.05）.Through comparison reflux positive rate,its sensitivity is 95.0%;specificity of 78.3%.Conclusion Color Doppler ultrasound of children gastro esophageal connection area probe and the anatomical structure of the esophageal connection area is normal or not to judge GER diagnosis has important clinical significance.For a high index of suspicion for GERD in children,His angle＇s ultrasonic testing can be used as the most convenient and preferred means of screening GER.