超声在先天性回肠闭锁中的诊断价值

Diagnostic Value of Ultrasound in Congenital Ileal Atresia

目的探讨超声在先天性回肠闭锁中的诊断价值.方法回顾性分析经手术及病理确诊为先天性回肠闭锁的患儿18例,探讨先天性回肠闭锁超声声像图特点,并与腹部X线检查结果比较.结果18例先天性回肠闭锁患儿中,17例患儿超声定位诊断先天性回肠闭锁;1例空腔脏器穿孔,腹腔游离气体干扰较重,不能定位诊断先天回肠闭锁,超声与临床符合率94%.17例超声表现为右下腹可见细小的肠管,细小肠管的直径约2.0~5.3 mm,平均3.6 mm;近端小肠扩张,蠕动快,张力高,扩张肠管直径15~41 mm,平均26 mm;结肠肠管细小,肠腔内容物少,肠腔内未见气体.超声检查提示梗阻点均位于回肠,诊断先天性回肠闭锁.1例因肠穿孔,气腹明显,超声检查仅能提示肠梗阻,空腔脏器穿孔.18例患儿中,超声检查一并诊断出腹水13例,空腔脏器穿孔1例,肠扭转13例,胎粪性腹膜炎7例,肠粘连2例,小肠肿物1例.腹部X线检查:完全性肠梗阻16例(其中气腹1例),不完全性肠梗阻2例.对于先天性回肠闭锁性肠梗阻的诊断,超声检查与腹部X线检查比较差异无统计学意义(P>0.05).结论超声检查和腹部X线检查均可诊断肠梗阻,而超声检查可进一步对先天性回肠闭锁患儿的肠梗阻的位置和原因定性,优于腹部X线检查.超声诊断先天性回肠闭锁与手术和病理结果的符合率较高.

Objective To investigate the diagnostic value of ultrasound in congenital ileal atresia.Methods A retrospective analysis was performed on 18 neonates with congenital ileal atresia confirmed by surgery and pathology.The ultrasonographic characteristics were analyzed,and compared with the abdominal X-ray findings.Results Among the 18 neonates,17 were diagnosed with congenital ileal atresia by ultrasound localization.In a case of cavity perforation,congenital ileal atresia could not be diagnosed by ultrasound localization due to abdominal free air interference.The coincidence rate between ultrasound and clinical diagnosis was 94%.The ultrasound findings of 17 cases showed small intestinal tracts in the right lower abdomen(diameter 2.0-5.3 mm,average 3.6 mm),proximal small intestine dilatation with fast peristalsis and high tension(diameter 15-41 mm,average 26 mm),and colonic stenosis and less content without intestinal gas.Ultrasonography showed that the obstructions were all located in the ileum in the 17 cases diagnosed with congenital ileal atresia.In the case of obvious pneumoperitoneum due to intestinal perforation,ultrasonography only indicated intestinal obstruction and cavity organ perforation.Among the 18 cases,ultrasonography showed ascites in 13 cases,cavity organ perforation in 1 case,intestinal torsion in 13 cases,meconium peritonitis in 7 cases,intestinal adhesion in 2 cases,and small intestinal mass in 1 case.Abdominal X-ray examination showed complete intestinal obstruction in 16 cases,including pneumoperitoneum in 1 case,and incomplete intestinal obstruction in 2 cases.There was no significant difference in the diagnosis of congenital ileal atresia ileus between ultrasound and abdominal X-ray examination.Conclusion Both ultrasound and abdominal X-ray can be used to diagnose intestinal obstruction.However,ultrasound is superior to abdominal X-ray examination for locating the obstruction and determining the cause.Ultrasound has a high coincidence rate with surgical and pathological results in the diagnosis of congenital ileal atresia.