超声在婴幼儿食管裂孔疝术前诊断中的临床价值

The clinical value of ultrasonography in the preoperative diagnosis of esophageal hiatal hernia in infants

目的:探讨婴幼儿食管裂孔疝的超声诊断特点及其与临床手术的相关性。方法:回顾性分析经超声诊断、消化道造影及手术证实的15例食管裂孔疝的超声图像特征,通过测量增大的食管裂孔内径与正常组45名进行统计学分析,探查膈上疝入物以及判断疝入物对于胸腔脏器的影响。结果:15例患儿首诊为食管裂孔疝均由超声实现,结合消化道造影及手术结果,诊断符合率100%。食管裂孔组的食管裂孔内径均有不同程度的增大,与正常组差异有统计学意义(P<0.05);膈上疝入物多样,超声探查包括胃组织15例,贲门14例,食管下段14例,部分肝脏组织3例,肠管1例,可单独疝入亦可联合疝入胸腔;疝入物压迫心肺造成肺不张2例,心脏移位1例。结论:婴幼儿食管裂孔疝超声特征明显,通过测量增大的食管裂孔内径,探查膈上疝入物以及判断心肺压迫情况,有助于临床判断食管裂孔疝分型,及早手术,超声可成为无创性筛选婴幼儿食管裂孔疝的首选方法。

Objective： To investigate the ultrasound diagnostic features of esophageal hiatal hernia in infants,and its correlation with the clinical surgery. Methods： The ultrasound image features of esophageal hiatal hernia diagnosed by ultrasound,gastrointestinal imaging and operation in 15 infants were retrospectively analyzed. The enlarging inner diameter of the esophageal hiatus and 45 normal esophageal hiatus were statistically analyzed. The inside tissue of hernia above diaphragm was detected,and the effect of which on thoracic organ was investigated. Results： Fifteen infants with esophageal hiatal hernia were diagnosed by ultrasound,gastrointestinal imaging combined with operation,the diagnostic coincidence rate was 100%. The inner diameter of the esophageal hiatal hernia in esophageal hiatal group increased at various degree,the difference of which between two groups was statistically significant（ P〈0. 05）.The ultrasound detection showed that the inside tissue of hernia included 15 cases of stomach,14 cases of cardia,14 cases of lower esophagus,3 cases of the part liver and 1 case of bowel,and these tissue could enter alone or together. The atelectasis in 2 cases and cardiac displacement in 1 case were identified. Conclusions： The ultrasound characteristics of esophageal hiatal hernia is obvious in infant. Measuring the inside diameter of esophageal hiatus and probing the tissue above the diaphragm and cardiopulmonary oppression can contribute to judge the esophageal hiatal hernia type,and operate as possible as early in clinic. Ultrasound may become the preferred method of noninvasive screening the esophageal hiatal hernia in infants.