超声门静脉积气征对极低出生体重儿坏死性小肠结肠炎的诊断价值

The diagnostic value of portal venous gas observed by ultrasound in necrotizing enterocolitis of very low birth weight infants

目的探讨超声门静脉积气征(portal venous gas,PVG)对于极低出生体重儿(very low birth weight,VLBW)坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的诊断价值。方法纳入成都市妇女儿童中心医院新生儿科2018年1月至2019年6月收治的生后出现腹部症状体征的VLBW患儿121例,均行腹部X射线平片和超声检查,并完整记录其临床诊治资料。综合分析两种影像学检查结果及临床表现,探讨超声下PVG征对极低出生体重NEC的诊断价值。结果纳入本研究的121例患儿于住院期间发生NEC 22例,其中生后3天内发生NEC 3例,发生喂养不耐受(feeding intolerance,FI)57例。22例NEC患儿中有17例(77.3%)在超声下发现PVG征象,8例(36.4%)在腹部X射线平片下出现PVG征象;57例FI患儿在超声下均未出现PVG征象,其中1例在腹部X射线平片下出现PVG征象。结论超声监测PVG对于NEC患儿发生NEC具有较强的预警能力,能帮助排除非NEC病例,并且在早期诊断NEC及动态观察方面优于腹部X射线片。

Objective To explore the value of ultrasound portal venous gas(PVG)for diagnosis of necrotizing enterocolitis(NEC)of very low birth weight(VLBW)infants.Methods From January 2018 to June 2019,121 VLBW infants admitted into the neonatal department of Chengdu Women's and Children's Central Hospital were included in this study.The patients with abdominal symptoms and signs quickly underwent the examination of abdominal X-ray plain film and abdominal ultrasound.The diagnostic value of PVG sign under ultrasound for NEC of VLBW was evaluated.Results Of the 121 cases,22 cases were diagnosed as NEC during hospitalization,in which 3 cases occurred within first 3 days,and 57 cases were diagnosed feeding intolerance(FI).PVG sign was detected by ultrasound in 17/22(77.3%)In the NEC patients,8(36.4%)cases had PVG sign under abdominal X-ray.All the patients with FI had no PVG sign under ultrasound,and 1 of them had PVG sign under abdominal X-ray.Conclusion Ultrasonic monitoring of PVG has a strong early warning ability for occurrence of NEC in VLBW infants.It can help to exclude non-NEC cases,and is superior to abdominal X-ray in early diagnosis of NEC and dynamic observation.