小儿肠旋转不良疑难病例超声特点及诊断价值研究

Study on the Ultrasonographic Characteristics and Diagnostic Value in Suspected Cases of Pediatric Intestinal Malrotation

目的:探讨小儿肠旋转不良疑难病例超声特点及诊断价值。方法:研究纳入2022年3月—2024年3月赣州市妇幼保健院收治的98例疑似肠旋转不良患儿,所有患儿均行X线造影诊断及超声诊断,使用手术病理检查结果作为金标准,观察小儿肠旋转不良疑难病例超声特点,并比较两种检测方法在诊断先天性肠旋转不良时的敏感度、特异度及准确度。结果:手术病理检查结果检测出肠旋转不良患儿95例,无肠旋转不良患儿3例;经超声检测病变主要表现为中上腹部出现中等大小的团块回声,可见典型或非典型漩涡征,上腹部静脉扩张,伴有肠壁水肿和肠间积液,以及肠壁血管的血流量减少。在95例肠旋转不良患儿中,经X线造影诊断出72例,经超声诊断出86例;超声诊断小儿肠旋转不良的准确度、敏感度分别为90.82%、90.53%,均高于X线造影诊断(P<0.05)。结论:超声诊断在小儿肠旋转不良疑难病例中显示出较X线造影更高的准确度、敏感度,其独特的超声特征在诊断小儿肠旋转不良方面具有重要的诊断价值。

Objective:To explore the ultrasonographic characteristics and diagnostic value in suspected cases of pediatric intestinal malrotation.Method:From March 2022 to March 2024,98 suspected cases of pediatric intestinal malrotation were included in the study at Ganzhou Maternal and Child Health Hospital.All children underwent X-ray imaging and ultrasound diagnostics,with surgical pathology results serving as the gold standard.Ultrasonographic features in these pediatric cases were observed,and the sensitivity,specificity,and accuracy of the two diagnostic methods were compared.Result:Surgical pathology confirmed intestinal malrotation in 95 cases,with 3 cases showing no malrotation.Ultrasonography primarily revealed moderate-sized mass echoes in the upper abdomen,typical or atypical whirlpool signs,expanded upper abdominal veins,accompanied by intestinal wall edema and inter-intestinal effusion,and reduced blood flow in intestinal wall vessels.Among the 95 cases,intestinal malrotation was diagnosed in 72 cases by X-ray imaging and in 86 cases by ultrasound.The accuracy and sensitivity of ultrasound diagnosis for pediatric intestinal malrotation were 90.82%and 90.53%,respectively,all of which were higher than those of X-ray diagnosis(P<0.05).Conclusion:Ultrasound diagnosis shows higher accuracy,sensitivity than X-ray imaging in pediatric cases of suspected intestinal malrotation.Its unique ultrasonographic features hold significant diagnostic value for identifying intestinal malrotation in children.