超声检查对儿童肠扭转缺血性改变的诊断价值

Diagnostic value of ultrasound in ischemic changes of intestinal volvulus in children

目的探讨超声征象在儿童肠扭转的诊断及肠管缺血性改变评估中的价值。方法回顾性分析2020年1月至2023年8月在徐州医科大学附属徐州儿童医院进行超声检查并经手术病理证实的77例儿童肠扭转的临床和超声资料,根据手术过程中有无肠缺血性改变分为缺血组(有肠缺血改变)和对照组(无肠缺血改变),比较两组间临床特征及各超声征象发生率。结果两组间临床资料对比结果显示,缺血组年龄分布明显小于对照组,差异有统计学意义(P<0.05)。两组间超声征象对比,缺血组中浑浊腹水、肠管扩张、肠系膜水肿及肠壁回声增强的发生率均高于对照组,差异有统计学意义(P<0.05)。ROC结果显示,浑浊腹水、肠管扩张、肠系膜水肿及肠壁回声增强预测肠扭转缺血性改变的AUC分别为0.677、0.654、0.612和0.596。结论在肠扭转的患儿中,年龄越小,存在浑浊腹水、肠管扩张、肠系膜水肿及肠壁回声增强等超声征象,有助于提示肠缺血。

Objective To investigate the value of ultrasonic signs in the diagnosis of intestinal volvulus and the evaluation of intestinal ischemic changes in children.Methods The clinical and ultrasonic data of 77 cases with intestinal volvulus confirmed by operation and pathology and preoperative ultrasound examination were retrospectively analyzed.According to the presence or absence of intestinal ischemic changes during operation,they were divided into an ischemic group(with intestinal ischemic changes)and a control group(without intestinal ischemic changes),and differences of clinical features and incidence of each ultrasonic sign between the two groups were compared.Results The comparison of clinical data between the two groups showed that the age distribution of the ischemic group was significantly lower than that of the control group,with a statistically significant difference(P<0.05).Comparison of the ultrasonic signs between the two groups showed that the incidence of turbid ascites,intestinal dilation,mesenteric edema,and enhanced intestinal wall echo in the ischemic group were higher than that in the control group,with a statistically significant differences(P<0.05).The results of ROC showed that the AUC of turbid ascites,intestinal dilatation,mesenteric edema and enhanced intestinal wall echo predicting ischemic changes of intestinal torsion were 0.677,0.654,0.612 and 0.596,respectively.Conclusion In children with intestinal volvulus,the younger the age,the more ultrasound signs such as turbid ascites,intestinal dilation,mesenteric edema,and enhanced intestinal wall echo are present,which are prone to intestinal ischemia.