经腹超声联合高频超声在小儿肠套叠中的诊断效能及在温盐水灌肠复位成败中的预测价值

Diagnostic efficacy of transabdominal ultrasound combined with high frequency ultrasound in pediatric intussusception and its predictive value in the success or failure of warm saline enema reduction

目的探讨经腹超声联合高频超声在小儿肠套叠中的诊断效能及在温盐水灌肠复位成败中的预测价值。方法回顾性分析超声科接诊的200例疑似肠套叠患儿的临床资料,所有患儿均接受经腹超声与高频超声检查。以钡剂灌肠X线检查结果为金标准,比较不同检查方法的阳性检出率、误诊率、漏诊率及诊断效能;比较不同检查方法在温盐水灌肠复位成败中的预测价值以及不同复位结果的超声表现。结果经腹超声联合高频超声诊断小儿肠套叠的误诊率、漏诊率、灵敏度、特异度、准确度、阴性预测值、阳性预测值优于经腹超声与高频超声单独诊断(P<0.05)。经腹超声联合高频超声预测温盐水灌肠复位成功率高于经腹超声与高频超声单独预测(P<0.05)。复位成功患儿的靶环征直径、同心圆直径、套鞘厚径及套筒征长度小于复位失败患儿,血流分级Ⅲ~Ⅳ级及无腹腔积液占比高于复位失败患儿(P<0.05)。结论经腹超声联合高频超声可有效提高小儿肠套叠的诊断效能,降低漏诊、误诊率。

Objective To investigate the diagnostic efficacy of transabdominal ultrasound combined with high frequency ultrasound in pediatric intussusception and its predictive value in the success or failure of warm saline enema reduction.Methods The clinical data of 200 children with suspected pediatric intussusception in the ultrasound department were retrospectively analyzed.All children underwent transabdominal ultrasound and high frequency ultrasound.Barium enema X-ray examination results as the gold standard,the positive detection rate,misdiagnosis rate,missed diagnosis rate and diagnostic efficacy of different examination methods were compared;the prediction value of different examination methods in the success or failure of warm saline enema reduction and the ultrasonic manifestations of different reduction results were compared.Results The misdiagnosis rate,missed diagnosis rate,sensitivity,specificity,accuracy,negative predictive value and positive predictive value of transabdominal ultrasound combined with high frequency ultrasound in the diagnosis of pediatric intussusception were better than those of transabdominal ultrasound and high frequency ultrasound alone(P<0.05).The success rate of warm saline enema reduction predicted by transabdominal ultrasound combined with high frequency ultrasound was higher than that predicted by transabdominal ultrasound and high frequency ultrasound alone(P<0.05).The diameter of the target ring sign,the diameter of the concentric circle,the thickness of the sheath and the length of the sleeve sign in the successful reduction children were smaller than those in the failed reduction children,and the proportion of blood flow gradeⅢ-Ⅳand no ascites in the abdominal cavity were higher than those in the failed reduction children(P<0.05).Conclusion Transabdominal ultrasound combined with high frequency ultrasound can effectively improve the diagnostic efficacy of pediatric intussusception,reduce the rate of missed diagnosis and misdiagnosis.