经腹超声联合肠镜检查在老年人缺血性肠病诊断及治疗中的应用  

Transabdominal ultrasonography combined with endoscopy in diagnosis and treatment of elderly ischemic bowel disease

作　　者：张龙方[1] 韩全利[2] 邵芙玲[3] 陈英[2] 李冬莉[1] 于元妹 姚克纯[1] 

机构地区：[1]解放军空军总医院 超声科,北京100042 [2]解放军空军总医院干部病房,北京100042 [3]解放军空军总医院保健办,北京100042

出　　处：《中华老年多器官疾病杂志》2014年第1期37-40,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的：探讨老年缺血性肠病的超声声像图特征及其临床应用价值。方法对2007年10月至2012年10月解放军空军总医院门、急诊及住院治疗的23例急性腹痛、便血老年患者先行经腹肠道超声检查，并结合临床及肠镜所见分析其声像图特征。结果全部病例均经结肠镜和临床证实，超声定位符合率82.6%（19/23），其中病变累及左半结肠12例（占52.2%），降结肠5例（占21.7%），乙状结肠3例（占13.0%），脾曲3例（占13.0%）。肠壁增厚0.61～1.91cm，病变累及范围10～19cm，病变肠壁呈均匀性及全周性增厚，正常肠壁结构层次模糊或消失，代之以不规则的低回声，受累肠腔稍变窄，肠壁蠕动不同程度减弱或消失。8例腹腔可见少量积液。9例于腹腔腹膜后区可见稍大淋巴结（长径＞0.6cm）。12例病变肠壁无明显血流显像，11例仅见稀疏点、短条状血流信号。结论经腹肠道超声有助于缺血性肠病的早期诊断，联合肠镜能明确病变的性质、部位、范围，对临床治疗具有指导意义。Objective To investigate the ultrasound image features of ischemic bowel disease（IBD） in the elderly and evaluate their significance in clinical practice. Methods Transabdominal ultrasonography was performed in 23 elderly out-and in-patients who were admitted to our hospital due to acute abdominal pain and hematochezia from October 2007 to October 2012. The ultrasound images were analyzed along with clinical manifestations and endoscopic findings. Results Diagnosis of IBD was confirmed in all cases by endoscopy and clinical manifestations. While, transabdominal ultrasonography established the diagnosis with an accuracy of 82.6%（19/23）. Ischemic lesions were identified in the left side of colon in 12 patients （52.2%）, on the descending colon in 5 patients （21.7%）, on the sigmoid colon in 3 patients （13.0%）, and on the splenic flexure colon in 3 patients （13.0%）. The thickness of colon wall was increased to 0.61 to 1.91cm. The length of involvement part ranged form 10 to 19cm. The involved colon was symmetrically and circumferentially thickened, and the normal structure of colon wall became unclear or disappeared, as irregular hypoechoic areas in the ultrasound images. The involved colon became slightly narrow in cavity, resulting in slowed or disappeared peristalsis. There was a little fluid sonolucent area in 8 patients, and swelled lymph nodes （〉0.6cm） in the retroperitoneal area in 9 patients. There were 12 patients without obvious blood flow signals, and 11 patients with only sparsely dotty or short strip-like blood flow signals. Conclusion Transabdominal ultrasonography is beneficial to the early diagnosis of IBD. It clarifies the nature, location, and area of the lesions when combined with endoscopy, and has instructive value for clinical treatment.

关 键 词：老年人 缺血性肠病 超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R592[医药卫生—诊断学]