先天性十二指肠梗阻的影像表现及检查方法选择  

The imaging options and findings of congenital duodenal obstruction

作　　者：孙焱[1] 袁理想[1] SUN Yan;YUAN Lixiang(Department of radiology,Tianjin Children’s Hospital,Tianjin 300134,China)

机构地区：[1]天津市儿童医院放射科,天津300134

出　　处：《国际医学放射学杂志》2021年第1期99-103,共5页International Journal of Medical Radiology

摘　　要：目的探讨不同影像检查方法对各种类型先天性十二指肠梗阻的诊断价值及检查方法的选择。方法回顾性分析经手术证实的48例先天性十二指肠梗阻患儿的产前超声、腹部立位X线平片、上胃肠道造影以及术前超声和CT的影像资料,观察胃肠道管径、充盈程度、运动和排空情况、梗阻端形态、邻近结构的解剖等,并计算各种影像检查方法的检出率。结果48例患儿均行产前超声检查及X线平片,检出率分别为58.3%(28/48)、83.3%(40/48);31例患儿行上胃肠道造影,检出率为100%(31/31);31例患儿行术前超声检查,检出率为67.7/%(21/31);8例患儿行CT检查,检出率为87.5/%(7/8)。其中,上胃肠道造影对各类型先天性十二指肠梗阻的检出率最高(均为100%)。X线平片可呈真性“双泡征”、“单泡征”或“双泡征”伴肠管生理性充气减少。上胃肠道造影主要表现为胃和近端十二指肠扩张,对比剂通过十二指肠完全或部分受阻和频繁逆蠕动。可见梗阻端呈“风兜状”,十二指肠空肠交界点和近段空肠位置异常及十二指肠腔内光滑充盈缺损影。术前超声检查主要表现为胃泡、十二指肠近端扩张,远端肠管充盈差,排空延迟和逆蠕动,还可见“隔膜样”强回声带,肠系膜上动脉与肠系膜上静脉倒置等。CT表现为胃泡、十二指肠近端的扩张,部分可见“漩涡征”。结论不同影像检查方法对各种类型先天性十二指肠梗阻的检出率不同,上胃肠道造影的检出率最高。需要结合临床表现、产前超声和腹部立位X线平片的影像表现,适当选择上胃肠道造影、术前超声或CT检查。Objective To explore thevaluesof different imaging optionsindiagnosing congenital duodenal obstruction.Methods Imaging data of 48 patients(27 males,21 females,median age 3 days)with congenital duodenal obstruction were retrospectively analyzed,the data included prenatal ultrasound,erect abdominal X-ray,upper gastrointestinal contrast study,preoperational ultrasound,and CT.The duodenaldiameter,filling,motility,empting of the gastrointestinal tract,and shape of proximal obstruction,adjacent structures,and position of mesenteric arteries and veins were observed.The positive rate of each imaging method was calculated.Results Allthe 48 patients conducted prenatal ultrasound and X-ray examination,with positive detection rates of 58.3%(28/48)and 83.3%(40/48)respectively;31 patients conducted upper gastrointestinal contrast examination with a positive detection rate of 100%;31 patients conducted preoperational ultrasound examination with a positive detection rate of 67.7/%(21/31);8 patients conducted CT examination with a positive detection rate of 87.5/%(7/8).Upper gastrointestinal contrast examination achieved the highest positive detection rate for all types of congenital duodenal obstruction(100%).X-ray examination manifested as true“double bubble sign”,“single bubble sign”or“double bubble sign”with less gas distal to the duodenum.Upper gastrointestinal contrast examination showed dilatation of stomach and duodenum,contrast agentblockingat the site of obstruction,and frequent anti-peristalsis.The“wind-sock sign”,malposition of the duodenojejunal junction and proximal jejunum,and smooth filling defect in the duodenal cavity were usually presented.The main manifestationsonpreoperational ultrasound examination included dilated stomach and duodenum,delayed gastric emptying,anti-peristalsis,and intrinsic obstruction.The characteristic appearances also included hyperechogenic diaphragm attached to the duodenal wall,and inverted superior mesenteric artery and superior mesenteric vein.CT examination showed di

关 键 词：十二指肠梗阻 体层摄影术 X线计算机 X线摄影术 超声 胃肠道造影 

分 类 号：R725.7[医药卫生—儿科] R445[医药卫生—临床医学]