超声在诊断婴儿肥厚性幽门狭窄中的应用价值

Effectiveness of Application of Ultrasonography in Diagnosis of Infantile Hypertrophic Pyloric Stenosis

目的探讨超声在诊断婴儿肥厚性幽门狭窄（IHPS）中的应用价值。方法回顾性分析691例临床怀疑IHPS患儿的超声诊断结果与临床诊断结果,以幽门肌层厚度（PMT）≥4.0 mm、幽门管长径（PCL）≥16.0 mm作为IHPS的超声诊断标准。结果超声诊断IHPS的敏感性为96%（254/265）、特异性为100%（426/426）,诊断符合率为98%（680/691）。254例超声真阳性患儿中,21例进行了两次超声检查,占8%（21/254）：首次超声检查均为阴性,PMT为1.7～3.8 mm;复查超声均为阳性,PMT为4.0～6.0 mm;幽门肌层增厚的速度为（0.21±0.19）mm/d,范围为0.07～0.83 mm/d。结论超声是一种有效、可靠的诊断IHPS的影像学方法,对于超声阴性而仍持续呕吐的患儿,应考虑患儿处于肥厚性幽门狭窄最初期的可能性,需复查超声,以避免漏诊。

Objective To evaluate the effectiveness of application of ultrasonography（US） in diagnosis of infantile hypertrophic pyloric stenosis（IHPS）. Methods Taking PMT（Pyloric Muscle Thickness） ≥4.0 mm and PCL（Pyloric Channel Length） ≥16.0 mm as the diagnostic criteria, the ultrasonographic findings of 691 children with clinically-suspected IHPS were analyzed retrospectively. Results The sensitivity, specificity and diagnostic accordance rate of US for IHPS were 96%（254/265）, 100%（426/426） and 98%（680/691） respectively. Among 254 patients with true-positive ultrasonographic findings, there were 21 patients with repeated ultrasound scans, accounting for 8%（21/254）. They were revealed negative with PMT ranging from 1.7 mm to 3.8 mm on first ultrasound scan and then were found positive with PMT ranging from 4.0 mm to 6.0 mm on the second ultrasound scan. The rate of pyloric muscle hypertrophy was（0.21±0.19） mm/d, ranging from 0.07 mm/d to 0.83 mm/d. ConclusionUS served as an effective and reliable imaging method for diagnosis of IHPS. The negative pyloric ultrasonographic findings might be due to the fact that the patient was in the very initial stages of development of IHPS. In view of this, a repeated ultrasound scan was necessary to be performed so as to avoid the missed diagnosis of patients with IHPS.