超声检查在消化道穿孔诊断中的临床价值

Clinical value in the diagnosm of digestive tract perforation by ultrasound examination

目的探讨超声检查在消化道穿孔中的诊断价值。方法回顾分析经手术证实的64例消化道穿孔的超声表现,并与腹部X线检查结果与手术结果进行对比分析。结果在64例消化道穿孔患者中,手术证实胃穿孔10例,十二指肠球部穿孔39例,阑尾穿孔14例,外伤致小肠破裂1例。术前超声提示消化道穿孔58例,病变的定性诊断符合率90.6%,其中发现腹腔游离气体41例,占64%;腹腔游离积液或局限性积液54例,占84%;局部网膜聚集23例,占35.9%,直接发现穿孔部位21例,占32.8%;腹部X线检查发现膈下游离气体44例,诊断符合率68.7%,与超声检查发现游离气体的符合率相差不大。结论 X线和超声检查均可发现腹腔内游离气体,但是超声还可以发现由消化道穿孔引起的腹腔积液、局部网膜聚集等征象,对腹腔脏器穿孔的检出率较高,具有很高的临床应用价值。

Objective To study the diagnostic value of ultrasound examination in the digestive tract perforation.Methods We retrospectively analysed the ultrasonic manifestation of 64 cases digestive tract which were proven by operation, and made contrastive analysis with the X-ray examination results and the operative results. Results Among 65 cases, there were 10 cases of gastric perforation, 39 cases of duodenal perforation, 14 cases of appendiceal perforation and 1 cases of small intestinal rupture caused by trauma. 58 cases of digestive tract perforation were found by preoperative ultrasonography and the coincidence rate was 90.6%. And we were found 41 cases of free intraperitoneal air（64%）, 54 cases of free peritoneal fluid or loculated fluid（84%）, 23 cases of the gathered omentum（gathered） and 21 cases were found the site of perforation（32.8%）.X-ray examination found 44 cases of free intraperitoneal air and the diagnosis coincidence rate was 68.7%. It was no statistically significant difference with ultrasonography. Conclusion The X-ray and the ultrasound examination all can be found free intraperitoneal air, but the ultrasound can also be found peritoneal effusion and local retinal aggregation. The ultrasound examination had higher detection rate for the digestive tract perforation and had great clinical practical value.