床旁超声诊断早产儿阑尾炎  

Bedside ultrasound for diagnosis of appendicitis in preterm infants

作　　者：李恒[1] 金笛 付佳[1] 司姝宇 Li Heng;Jin Di;Fu Jia;Si Shuyu(Department of Neonatology,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院新生儿科,长春130021

出　　处：《中华围产医学杂志》2019年第9期633-636,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的研究早产儿阑尾炎的超声影像学特点。方法回顾性分析吉林大学第一医院新生儿科2012年11月至2019年1月经床旁超声诊断阑尾炎的早产儿共28例。分析这些患儿的临床资料、腹部超声所见、治疗方法、手术结果和结局。对数据资料采用描述性统计学方法进行分析。结果研究期间,共28例早产儿经床旁超声诊断为阑尾炎,其中21例(75.0%)为男性,7例(25.0%)为女性。28例均伴有穿孔。5例(17.8%)具有阑尾炎的直接征象,即超声显示阑尾部分结构,并显示穿孔部位;其余23例(82.2%)具有阑尾炎的间接征象,包括6例肝与右肾之间见不均质或低回声,7例右下腹肠间隙不均质低回声,以及10例右下腹肠间隙游离性积液,透声不佳,周围肠管结构紊乱。28例中的21例(75.0%)表现为右下腹肠壁增厚、肠蠕动消失,肠间隙见积液回声且透声不佳,明确诊断后行急诊手术治疗,术中证实为阑尾炎并穿孔,手术治疗效果满意,均恢复后出院。7例(25.0%)超声表现为包裹局限,采取内科保守治疗。其中1例超声随访发现粘连性肠梗阻,行手术治疗,术中明确为阑尾穿孔后局部形成包裹,周围肠管粘连形成梗阻;其余6例均保守治疗成功,腹腔积液逐渐减少,周围网膜回声正常,炎症指标及腹部症状逐渐改善,出院后随访,均未发生肠梗阻。结论早产儿阑尾炎临床症状不典型,易合并穿孔。床旁超声以间接征象为主,部分患儿可观察到直接征象。床旁超声可以作为早产儿阑尾炎的重要检查方法。Objective To investigate the sonographic features of appendicitis in preterm infants. Methods A total of 28 cases of premature infants with acute appendicitis diagnosed by bedside abdominal ultrasound in the First Hospital of Jilin University from November 2012 to January 2019 were recruited. Basic clinical information, abdominal ultrasound images, surgical results, management and outcomes were collected and analyzed. Descriptive statistical methods were used for data analysis. Results Among the 28 cases, 21 (75.0%) were males and seven (25.0%) were females. All of them were diagnosed as having acute appendicitis with perforation according to the bedside ultrasound. Five (17.8%) presented direct signs of appendicitis, i.e. partial structure of the appendix and perforation site. The other 23 (82.2%) showed indirect signs, including heterogeneous echotexture or hypoechoic patterns between the liver and right kidney in six cases, heterogeneously hypoechoic areas between the bowels in the right lower abdomen in seven cases, and dissociative effusion between the bowels in the right lower abdomen with poor sound transmission and disorder of surrounding intestinal structure in ten cases. Twenty-one out of the 28 cases (75.0%) exhibited bowel wall thickening at right lower abdomen, absence of intestinal peristalsis and effusion echoes between the intestines with poor sound transmission. Emergent surgeries were performed and diagnoses of appendicitis with perforation were confirmed. All the 21 cases were discharged after full recovery. Seven cases (25.0%) showed confined cystic images and received conservative treatment. One of them developed adhesive intestinal obstruction during follow-ups and underwent surgical treatment, during which local formations of wrapping after appendiceal perforation and obstruction due to surrounding intestinal adhesion were observed. The other six cases recovered after conservative management with gradually reduced peritoneal effusion, normal omental echo patterns and improved inflammatory i

关 键 词：阑尾炎 即时检验 超声检查 婴儿 早产 

分 类 号：R445.1[医药卫生—影像医学与核医学]