产前超声诊断消化道梗阻对患儿出生后手术方案的前瞻性指导意义

Prospective guiding significance of prenatal ultrasound diagnosis of gastrointestinal obstruction for postnatal surgery in children

目的探讨产前超声在先天性消化道梗阻诊断中的应用价值,及其对患儿出生后手术方案的指导作用。方法选取2019年6月至2021年6月在台州市第一人民医院出生并接收手术治疗的108例消化道梗阻新生儿作为研究对象,其中78例经产前超声明确诊断为消化道梗阻(研究组),产后早期实施手术,30例在出生后被诊断为消化道梗阻(对照组),择期手术。对先天性消化道梗阻的产前超声图像特征进行分析,并对比两组患儿的手术相关情况。结果产前超声诊断出十二指肠狭窄/闭锁40例,其超声表现为“双泡征”,小肠狭窄/闭锁13例,表现为大小不等、类似蜂窝状的无回声区,结肠狭窄/闭锁10例,肠管扩张,腹腔内环形分布,先天性肠扭转不良8例,超声表现为“漩涡征”,肛门闭锁7例,超声表现为“双叶征”。研究组患儿出生后手术时间及住院时间均显著短于对照组(P<0.05);两组术后进食时间、术后排便时间比较,差异均无统计学意义(P>0.05)。两组患儿术后均未发生肠粘连、肠梗阻症状,术后饮食及排便情况正常。研究组患儿的术后恢复自主呼吸率、治愈率均显著高于对照组(P<0.05)。结论产前超声检查可明确胎儿消化道扩张的程度、部位及特征,其对先天性消化道梗阻有较高的诊断准确性,经产前超声确诊的消化道梗阻患儿,经多科室会诊后制定合理的处理方案,有助于胎儿在娩出后尽早完成手术,解除梗阻,从而提高手术效果,改善患儿预后。

Objective To explore the value of prenatal ultrasound in the diagnosis of congenital gastrointestinal obstruction and to guide the operation plan after birth.Methods A total of 108 neonates with gastrointestinal obstruction who were born and received surgical treatment at Taizhou First Peopleʼs Hospital from June 2019 to June 2021 were selected for the study.78 of them were clearly diagnosed with gastrointestinal obstruction by prenatal ultrasound(study group)and underwent surgery early after delivery,while 30 were diagnosed with gastrointestinal obstruction after birth(control group)and underwent surgery at an elective date.The prenatal ultrasound image characteristics of congenital gastrointestinal obstruction were analyzed and the children in the two groups were compared in relation to the surgery.Results Forty cases of duodenal stenosis/atresia were diagnosed by prenatal ultrasonography.The ultrasonographic manifestations of duodenal stenosis/atresia were“double vesicles”and 13 cases of small intestine stenosis/atresia.The ultrasonographic manifestations were as follows:unequal size,honeycomb-like anechoic area,10 cases of colon stenosis/atresia,dilatation of intestinal canal,circular distribution in abdominal cavity,8 cases of congenital malvolvulus,7 cases of“double leaf sign”.The operation time and hospital stay in the study group were significantly shorter than those in the control group(P<0.05);there was no significant difference between the two groups in eating time and defecation time(P>0.05).No intestinal adhesion or obstruction occurred in the two groups after operation,and the diet and defecation were normal after operation.The recovery rate of spontaneous breathing and the cure rate in the study group were significantly higher than those in the control group(P<0.05).Conclusion Prenatal ultrasonography can confirm the extent,location and characteristics of fetal gastrointestinal dilatation.It has high diagnostic accuracy for congenital gastrointestinal obstruction. Children with gastrointestinal obstruction diagnosed by prenatal ultrasonography can make reasonable treatment plan after consultation with multiple departments, which can help the fetus complete the operation as soon as possible after delivery, relieve the obstruction, improve the operation effect and improve the prognosis of children.