儿童先天性膈疝的超声表现及诊断价值

Ultrasonic manifestations and diagnostic value in congenital diaphragmatic hernia in children

目的分析儿童先天性膈疝的超声表现及超声对其诊断价值。方法选择2012年1月至2019年1月,屯昌县人民医院收治的先天性膈疝患儿30例,采用超声和X线片对患儿左、右膈疝和疝内容物进行诊断,并通过手术证实其对儿童先天性膈疝诊断的准确性。结果手术结果表明,30例先天性膈疝的患儿中,左侧疝26例,右侧疝4例;疝内容物为空腔器官者9例,空腔与实质器官合并者21例。先天性膈疝患儿超声表现为上腹部膈肌回声中断,可见肺下界上移;经胸部背、侧腰部扫视隔离肺可见胸腔内与其他肺组织不相连的囊实混合回声区;经腹部扫视,空腔器官疝入则腹腔显示较空虚,实质性器官疝入,在正常位置不能显示器官结构。先天性膈疝患儿X线片表现为膈上可见半圆形肿块影,心脏及气管向健侧移位,腹部较空虚密实。超声诊断对先天性膈疝患儿膈疝位置和疝内容物的判断准确率(100.00%和90.00%)显著高于X线片(93.33%和56.67%,P<0.05)。结论超声诊断能通过回声和图像结构对儿童先天性膈疝的位置和疝内容物进行判断,其诊断准确率显著高于X线片,值得在临床推广应用。

Objective To analyze the ultrasonic manifestations of congenital diaphragmatic hernia in children and to investigate its diagnostic value.Methods Between January 2012 and January 2019,30 children with congenital diaphragmatic hernia admitted to Tunchang people's hospital were selected.Patients were diagnosed with left and right diaphragmatic hernia and hernia contents by ultrasonic and radiological techniques,and the accuracy of the diagnosis of congenital diaphragmatic hernia in children was confirmed by surgery.Results The results of the surgery showed that among the 30 children with congenital diaphragmatic hernia,26 had left hernia and 4 had right hernia.Hernia contents were cavity organs in 9 cases and cavity and substantial organs in 21 cases.The sonographic findings of the children with congenital diaphragmatic hernia were disruption of the diaphragm echo in the upper abdomen,and the lower boundary of the lung was shifted upward.By scanning the back and side of the thorax and waist to isolate the lung,we could see the mixed echo area of the chest cavity which was not connected with other lung tissues.Through the abdominal scan,the cavity organ hernia showed a relatively empty abdominal cavity,substantial organ hernia,and in the normal position it could not show the organ structure.The X-ray findings of the children with congenital diaphragmatic hernia showed a semicircular mass shadow above the diaphragm,the heart and trachea shifted to the healthy side,and the abdomen was relatively empty and dense.The accuracy rate of ultrasonic diagnosis for position of diaphragmatic hernia,and hernia contents(100.00%and 90.00%)was significantly higher than that of X-ray(93.33%and 56.67%,P<0.05).Conclusion Ultrasonic diagnosis can estimate the position and contents of congenital diaphragmatic hernia in children through echo and image structure,and its accuracy rate is significantly higher than that of X-ray,which is worthy of clinical promotion.