新生儿坏死性小肠结肠炎影像学与临床相关性的回顾分析  

Imaging assessment of neonatal necrotizing enterocolitis

作　　者：王家蓉[1] 余加林[1] 李广红[1] 王敏[1] 高波[1] 李慧繁[1] 陈佳彬[1] 张聪[1] 

机构地区：[1]重庆医科大学附属儿童医院新生儿诊治中心,400014

出　　处：《中华儿科杂志》2013年第5期331-335,共5页Chinese Journal of Pediatrics

摘　　要：目的 回顾性分析新生儿坏死性小肠结肠炎（NEC）影像学表现与临床的关系,提高对其影像学的认识及诊断水平.方法 选取2006年1月1日至2011年12月31日,重庆医科大学附属儿童医院新生儿内、外科收治NEC患儿211例,对其影像学进行总结,分析患儿影像学指标与临床表现及手术的关系.结果 211例中,腹部X线平片无明显变化的40例（19.0％）,腹部X线平片动态好转的47例（22.3％）,腹部X线平片动态进展恶化的23例（10.9％）.腹部X线平片无变化组,预后好与预后差阳性率分别为97.5％、2.5％,腹部X线平片好转组,预后好与预后差阳性率分别为97.9％、2.1％,腹部X线平片恶化组,预后好与预后差阳性率分别是56.5％、43.5％,3组差异有统计学意义（X2 =31.742,P ＜0.01）.腹部X线平片和腹部B超诊断气腹的阳性率分别为16.0％（12/75）和1.3％（1/75）,（x2=10.191,P＜0.05）,对门脉积气的阳性率分别为1.3％ （1/75）、12.0％（9/75）,（x2=6.857,P＜0.05）.手术时机选择与腹部X线平片显示为气腹（OR=19.543）及肠梗阻（OR=19.527）关系最密切（P＜0.01）.结论 腹部X线平片是检查NEC的主要方法,腹部X线平片对气腹检测阳性率高,腹部B超对检出门脉积气更敏感,两者互相补充.手术时机选择与腹部X线平片查出气腹或肠梗阻关系最为密切.Objective To improve the understanding of recognizing and diagnosis of neonatal necrotizing enterocolitis （NEC）,imaging assessment of neonates with NEC was analyzed retrospectively.Method Data of 211 cases of NEC were retrospectively collected from the Department of Neonatology,Children＇s Hospital of Chongqing Medical University between Jan.1st 2006-Dec.31st 2011.Result Analysis of abdominal X-ray of 211cases showed that there were 40 cases （19.0%） who had no changes on each X-ray,47 cases （22.3%） had improvement and 23 cases （10.9%） became worse.In the group of no changes,positive rate with good prognosis was 97.5% and with poor prognosis,it was 2.5%.In the group of improvement,positive rate with good prognosis was 97.9%,and the contrary was 2.1%.Positive rate with good prognosis was 56.5%,and the contrary was 43.5% in worse group.Chi-square analysis of the three groups showed x2 =31.742,P 〈 0.01.Comparison of detection rate of pneumoperitoneum on abdominal X-ray （16.0%,12/75） and Doppler US （1.3%,1/75）,x2 =10.191,P 〈0.05,portal pneumatosis on abdominal X-ray（1.3%,1/75） versus Doppler US （12.0%,9/75）,x2 =6.857,P 〈 0.05.Surgical timing mostly corresponded to pneumoperitoneum （OR =19.543） and intestinal obstruction （OR =19.527） of abdominal X-ray.The logistic regression equation is y=-2.915-1.588x1 ＋ 2.972x4 ＋2.973x7 ＋ 1.711x9 （x2 =101.705,P 〈 0.01）.Conclusion Abdominal X-ray is the most important method of diagnosis of NEC,the group of deterioration of abdominal X-ray has obvious bad prognosis differ from no change group and better group.Comparison with abdominal X-ray and Doppler US,the former in pneumoperitoneum positive rate was higher than the latter,at the same time,portal pneumatosis on Doppler US is more sensitive to abdominal X-ray,the value of two imaging assessments both supplement each other.Surgical timing mostly corresponds to pneumoperitoneum and intestinal obstruction. Keywords：Enterocolitis necrotizing;Diagnostic imaging;Infant,newborn

关 键 词：小肠结肠炎 坏死性 诊断显像 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]