高频超声诊断非洲儿童肠伤寒穿孔的价值

High Frequency Ultrasound in the Diagnosis of Intestinal Typhoid Perforation Among African Children

目的肠伤寒穿孔是非洲国家儿童死亡的主要病因之一,早期诊断是降低死亡率的关键。本研究探讨高频超声早期诊断儿童肠伤寒穿孔的价值。资料与方法选取2014年10月—2015年10月中国援尼日尔医疗队工作点马拉迪地方医院外科收治的96例肠伤寒穿孔患儿,回顾性分析其腹部超声表现,即腹腔内游离气体、积液,肠壁厚度以及肝、脾、淋巴结肿大等,并与立位腹部X线平片对照。结果96例肠伤寒穿孔患儿均经手术证实。超声显示腹部游离气体35例(36.46%),腹部X线平片显示腹部游离气体25例(26.04%),差异有统计学意义(P<0.05)。超声显示腹腔内游离积液87例(90.62%),回盲部肠管壁增厚79例(82.29%),回盲部淋巴结肿大80例(83.33%),阑尾肿大39例(40.62%),脾肿大83例(86.46%),肝肿大39例(40.62%),胆囊炎性改变40例(41.67%)。术前超声准确判断肠穿孔位置64例(66.67%)。立位腹部X线平片不能准确提示上述信息。结论超声显像能较准确地显示儿童肠伤寒穿孔的位置及其相关并发症,为临床提供可靠的诊断信息,可以作为早期诊断儿童肠伤寒穿孔的首选检查方法。

Purpose Intestinal typhoid perforation is one of the main etiology of children＇s death in Africa. Early diagnosis is the key to reduce mortality. This paper aims to discuss the value of high-frequency ultrasound（US） in early diagnosis of pediatric intestinal typhoid perforation. Materials and Methods Ninety-six children with pediatric intestinal typhoid perforation in the Department of Surgery, Regional Hospital of Maradi, Niger, from October 2014 to October 2015 were retrospectively analyzed both by standing abdominal X-ray and ultrasonic features, including sub-phrenic free gas, abdominal effusion, intestinal wall thickness, hepatomegaly, splenomegaly and lymphadenectasis. Results All patients with intestinal typhoid perforation were confirmed by surgery. 35 cases（36.46%） were detected sub-phrenic free gas by using high-frequency US and 25 cases（26.04%） by standing abdominal X-ray, respectively（P〈0.05）. High-frequency ultrasound scan revealed free abdominal fluid in 87 cases（90.62%）, iieocecal intestinal wall thickening in 79 cases（82.29%）, swollen mesenteric lymph nodes in 80 cases（83.33%）, swollen appendix in 39 cases（40.62%）, splenomegaly in 83 cases（86.46%）, hepatomegaly in 39 cases（40.62%）, cholecystitis changes in 40 cases（41.67%）. Preoperative high-frequency US accurately identified the location of perforation in 64 cases（66.7%）. However, these features can＇t be accurately identified by standing abdominal X-ray. Conclusion High-frequency US can accurately show the location of pediatric intestinal typhoid perforation and its associated complications, provide reliable diagnostic information for clinical, which can be used as the main method for early diagnosis of pediatric intestinal typhoid perforation.