小儿原发性腹膜炎的超声诊断

Ultrasonic Diagnosis of Primary Peritonitis in Children

目的总结原发性腹膜炎的超声声像图特征,归纳其鉴别诊断要点.方法对2008年11月至2014年11月期间所有因腹痛、腹胀、呕吐或伴发热而就诊的患儿进行详细超声检查,尤其注重肠系膜及腹腔积液等情况,将所有影像学资料留档.通过随访,最终将23例有手术证实的病人作为研究对象.对其就诊原因、临床表现、主要阳性体征、实验室检查及其他影像学检查结果,重点探讨超声声像图特征及鉴别诊断要点.结果(1)共23例患儿纳入研究,男4例、女19例,年龄41 d^9岁11月,平均(5.1±0.2)岁,从出现症状到确诊时间为2~9 d,平均(5.3±2.1)d;(2)最常见的就诊原因和实验室检查阳性结果分别为:腹痛、腹胀和末梢血白细胞及中性粒细胞增高;(3)91.3%(21/23)患儿行超声检查时发现肠系膜增厚、回声增强,彩色多普勒显示条状血流信号.82.6%(19/23)患儿发现腹腔积液.60.1%(14/23)患儿发现肠系膜淋巴结肿大.腹腔部分肠管肠壁增厚及肠腔积液56.5%(13/23);(4)患儿同期行CT检查,其39.1%(9/23)发现肠腔积液.结论(1)小儿急性原发性腹膜炎病因复杂、起病隐匿、临床表现缺乏特征性,术前确诊比较困难;(2)超声能很好的显示肠系膜、腹腔积液及肠壁的特征性表现,能为临床提供有价值的诊断信息;(3)原发性腹膜炎超声声像图需要与继发性腹膜炎或结核性腹膜炎等进行鉴别;(4)超声检查对原发性腹膜炎的敏感性高于CT.

Objective To deeply recognize the knowledge of rare acute abdomen of primary peritonitis in children.In order to develop the diagnostic ability of ultrasound, we investigated the ultrasonographic characteristics of primary peritonitis and induce main points of differential diagnosis.Methods Patients with the abdominal pain, abdominal distension, vomiting and patients with fever from November 2008 to November 2014 were received ultrasound examination.In the end, there were 23 patients entering the investigation.The symptoms, positive physical examination, laboratory examination results, the other imaging manifestations,treatment and curative effect of the patients were recorded so as to emphasize the ultrasonographic features and main points of differential diagnosis.Results（1） Of the 23 patients, the ratio of male to female was 4： 19.The patients＇ ages were 41 days ∽9 years and 11 months and the mean duration between the onset of the disease and making right diagnosis was 2 days ∽9 days;（2） The commonest complains and physiochemical examination results were abdominal pain, abdominal distension, leukocytes of perpheral blood elevation and neutrophils elevation;（3） All patients receiving ultrasound examination and mesenteric thickening and more powerful echo were observed only in 91.3%（21/23） of them.Abdominal cavity effusion in 82.6%（19/23）, mesenteric lymphadenectasis in 60.1%（14/23）,abdominal part of intestinal wall thickening and intestinal effusion in 56.5%（13/23） was observed;（4） At the same time, CT scanning showed intestinal effusion in 39.1%（9/23） of children patient.Conclusion（1） Primary peritonitis in children is a very rare disease and it has no specific manifestation.It is difficult to diagnose before surgery;（2） The disease is characterized by mesenteric thickening,abdominal cavity effusion and so on.Ultrasound is the evaluation of diagnostic information;（3） The ultrasonographic features will be identified of primary peritonitis with secondary peritonitis or tuberculous peritonitis in diagnosing;（4） So the sensitivity of ultrasound is higher than the detection of CT in primary peritonitis.