先天性肥厚性幽门狭窄的超声诊断标准探讨

Discussion on ultrasonic diagnostic criteria of congenital hypertrophic pyloric stenosis

目的探讨先天性肥厚性幽门狭窄(CHPS)的超声诊断标准。方法选取2013年1月至2016年1月在我院行手术治疗的先天性肥厚性幽门狭窄患者206例,同时选取在本院做儿童保健的正常婴幼儿100例作为对照,比较两组超声测量值的差异;比较超声测量值与手术测量值的差异;以及超声评分诊断CHPS的ROC曲线分析。结果 CHPS患者的超声图像显示:幽门管明显增厚且呈梭形低回声,浆膜层为高回声,黏膜为强回声,幽门管腔为无回声,幽门管横切面呈"靶环征",纵切面呈"宫颈征"。CHPS患者的超声评分、幽门管肌层厚度、幽门管长度高、幽门管直径高于正常对照,且差异具有统计学意义(t值分别99.77、45.34、29.24、38.42,均P<0.05);两组的胃体部肌层厚度的差异无显著差异(t=0.99,P>0.05)。CHPS患者幽门管长度、幽门厚度、幽门管直径、幽门管肌层厚度的超声测量值与手术测量值的差异均无统计学意义(t值分别1.62、0.57、1.82、1.78,均P>0.05)。ROC曲线分析结果显示:超声评分诊断CHPS的阈值为4.49、灵敏度85.92%、特异度77.00%、约登指数0.629、ROC曲线下面积为88.82%。结论先天性肥厚性幽门狭窄的超声诊断可根据超声动图,超声测量值和超声评分进行综合评判。

Objective To investigate the ultrasonic diagnostic criteria of congenital hypertrophic pyloric stenosis（ CHPS）. Methods Totally206 cases of CHPS for surgery in Children＇s Hospital of Maternal and Child Health Hospital were selected from January 2013 to January2016,and 100 normal infants for health care were selected as controls at the same time. Comparison was made in the difference of ultrasonic measurements between two groups and the difference between ultrasound and operation measurement. And ROC curve analysis was conducted in ultrasound score diagnosis of CHPS. Results Ultrasound images of patients with CHPS revealed pyloric thickening and spindle shaped hypoecho,hyperecho in serosa,strong echo in mucosa,echoless in pyloric lumen. Pyloric canal cross section showed target sign and the longitudinal section showed cervical syndrome. The ultrasound score,pyloric muscle thickness,pyloric canal length and diameter of pylorus in cases of CHPS were higher than those in normal controls,and the differences were statistically significant（ t value was 99. 77,45. 34,29. 24 and 38. 42,respectively,all P〈0. 05）. There was no significant difference in the thickness of muscular layer between two groups（ t = 0. 99,P〉0. 05）. The ultrasound measurements of pyloric canal length,pyloric thickness,pyloric canal diameter and pyloric muscle thickness in CHPS patients were not statistically different from surgical measurements（ t value was 1. 62,0. 57,1. 82 and 1. 78,respectively,all P〉0. 05）. ROC curve analysis showed that the threshold of ultrasound score in diagnosis of CHPS was 4. 49,the sensitivity was 85. 92%,the specificity was 77. 0%,the Jorden index was 0. 629,and the area under ROC curve was 88. 82%.Conclusion Ultrasound diagnosis of CHPS can be made according to ultrasound dynamic images,ultrasonic measurements and ultrasound score for comprehensive evaluation.