儿童大网膜扭转超声诊断分析11例

Ultrasound diagnosis of omentum torsion in 11 children

目的探讨超声对儿童大网膜扭转的诊断价值。方法收集2017年3月至2019年10月来哈尔滨市儿童医院就诊的11例大网膜扭转患儿的临床资料,回顾性分析其超声二维图像、彩色多普勒声像图表现,并与手术结果对比分析,总结其超声诊断特点,分析漏诊原因。结果11例患儿中,右上腹大网膜扭转7例,右中腹大网膜扭转1例,右下腹大网膜扭转1例,中上腹大网膜扭转1例,左上腹大网膜扭转1例。术前超声正确诊断10例(90.9%),漏诊1例(9.1%)。超声的特征性表现为局部大网膜增厚,回声增强,多位于右上腹,整体形态呈三角形或纺锤形,增厚网膜头侧可探及旋涡状略低回声团块。10例确诊病例均经手术证实为大网膜扭转。漏诊病例首诊超声提示大网膜炎性改变,最终经手术证实为大网膜扭转合并梗死。结论超声诊断儿童大网膜扭转具有较高的准确性,可为临床治疗提供术前诊断依据。

Objective To explore the diagnostic value of ultrasound in children with omental torsion.Methods Collected the clinical data of 11 children with omental torsion who came to Harbin Children's Hospital from March 2017 to October 2019.A retrospective analysis was performed on the two-dimensional ultrasound images and color Doppler sonograms of 11 children with omental torsion.Ultrasound diagnostic results were compared with surgical results.The diagnostic characteristics were summarized and the reasons of missed diagnosis were analyzed.Results In the 11 cases included,7 had right upper abdomen omental torsion occurred in the right upper abdomen,1 in the right middle abdomen,1 in the right lower abdomen,1 in the middle and upper abdomen,and 1 in the left upper abdomen.Preoperative ultrasound correctly diagnosed 10 cases(90.9%),but missed 1 case(9.1%).Characteristic ultrasound features included local omental thickening,echo enhancement,being mostly located in the right upper abdomen,triangle or spindle shape,and presence of"whirlpool"slightly lower echo mass in the head side of thickened omentum.Ten cases were confirmed by surgery as omentum torsion.The missed case showed inflammatory changes of the omentum at the initial diagnosis,which was finally diagnosed by surgery as omentum torsion and omental infarction.Conclusions Ultrasound diagnosis of omentum torsion in children has high accuracy and can provide a preoperative diagnostic basis for clinical treatment.