腹部超声在新生儿坏死性小肠结肠炎诊断及病情评估中的价值

Value of abdominal ultrasound in the diagnosis of neonatal necrotizing enterocolitis and evaluation of disease severity

目的探讨腹部超声检查对新生儿坏死性小肠结肠炎(NEC)的诊断价值及其在NEC病情评估中的意义。方法回顾性分析2013年7月至2015年1月84例NEC患儿的临床资料。根据修正Bell-NEC分级诊断标准分为NEC疑似组(n=44)、确诊组(n=40);另根据临床转归分为内科治愈组(n=58)和手术/死亡组(n=26),比较腹部超声及腹部X线平片检查结果在各组中的改变。结果在确诊组,腹部超声对门静脉积气、肠管扩张的检出率显著高于腹部平片(P<0.05)。手术/死亡组腹部超声显示肠管扩张、肠壁增厚、腹腔积液及腹腔游离气体的检出率显著高于内科治愈组(P<0.05);腹部平片仅显示肠管扩张及腹腔游离气体多见于手术/死亡组(P<0.05)。结论腹部超声在NEC的诊断中有重要作用;超声表现对预测疾病的严重程度有预测作用。

Objective To investigate the value of abdominal ultrasound in diagnosing neonatal necrotizing enterocolitis（NEC） and its significance in evaluating the disease severity. Methods The clinical data of 84 neonates who were diagnosed with NEC between July 2013 and January 2015 were analyzed retrospectively. According to the modified Bell-NEC staging criteria, these neonates were divided into a suspected NEC group（n=44） and a confirmed NEC group（n=40）; according to clinical prognosis, they were divided into a medical treatment and full recovery group（n=58） and a surgery/death group（n=26）. The changes in the results of abdominal ultrasound and abdominal X-ray plain film were compared between groups. Results In the confirmed NEC group, abdominal ultrasound showed significantly higher detection rates of portal venous gas and dilatation of the intestine than abdominal X-ray plain film（P〈0.05）. Compared with the medical treatment and full recovery group, the surgery/death group had significantly higher detection rates of dilatation of intestine, bowel wall thickening, peritoneal effusion and free intraperitoneal air（P〈0.05）. Dilatation of the intestine and free intraperitoneal air shown by abdominal X-ray plain film were more common in the surgery/death group. Conclusions Abdominal ultrasound is useful for the diagnosis of NEC. Ultrasonic findings can contribute to the prediction of the severity of NEC.