浅表超声与X-线上消化道造影检查诊断新生儿上消化道梗阻性疾病的效果比较

Comparison of high frequency ultrasound and upper gastrointestinal barium examination in diagnosis of upper gastrointestinal obstruction in neonates

目的:探讨浅表超声与X-线上消化道造影检查对新生儿上消化道梗阻性疾病的诊断价值。方法:回顾性分析2008年11月至2015年7月温州医科大学附属第二医院新生儿科收治的245例患儿,经手术证实为上消化道梗阻性疾病,采用浅表超声和X-线上消化道造影检查,比较两者在上消化道梗阻部位和病因诊断中的优劣。结果:浅表超声与X-线上消化道造影对于上消化道梗阻部位判断的总正确率相仿,差异无统计学意义(95.1%vs 97.1%,P>0.05);对于上消化道梗阻病因的判断,浅表超声优于X-线上消化道造影(93.5%vs 64.6%,P<0.05),主要体现在幽门水平梗阻病因(先天性幽门肥厚狭窄、幽门管闭锁或狭窄);在食道水平梗阻部位及病因的判断X-线上消化道造影优于浅表超声(P<0.05)。结论:在新生儿上消化道梗阻性疾病诊断中,浅表超声检查可作为首选,对于超声不明原因的呕吐可结合X-线上消化道造影联合诊断。

Objective： To explore the value of high frequency ultrasound and upper gastrointestinal barium examination for the diagnosis of upper gastrointestinal obstruction in neonates. Methods： A retrospective analy- sis was performed to review high frequency ultrasound and upper gastrointestinal barium examination of 245 neonates with upper gastrointestinal obstruction were confirmed by post-operative pathology in Neonatal Ward of the Second Affiliated Hospital of Wenzhou Medical University during November 2008 to July 2015. The two methods were compared in the location and the etiological factor with upper gastrointestinal obstruction respec- tively. Results： Between high frequency ultrasound and upper gastrointestinal barium examination, there were no significant difference in the location diagnostic accuracy with upper gastrointestinal obstruction （95.1% vs 97.1%, P〉0.05）, but there were significant difference in the etiological factor with upper gastrointestinal obstruc- tion, and high frequency ultrasound were better （P〈0.05）, especially showed in pylorus level （including congeni- tal hypertrophy or stegnosis of pylorus, atresia or stegnosis of pyloric canal）. Otherwise in the location and the etiological factor of esophagus level obstruction, upper gastrointestinal barium examination were better than high frequency ultrasound （P〈0.05）. Conclusion： In the diagnosis of upper gastrointestinal obstruction, we can firstly consider high frequency ultrasound and combination of the two examination when vomiting of unknown cause in high frequency ultrasound.