彩色多普勒超声对儿童鳃裂畸形的诊断价值  

Diagnostic value of color Doppler ultrasonography in children with branchial cleft deformity

作　　者：张号绒 侯艳青 许云峰[1] 童易如[2] Zhang Haorong;Hou Yanqing;Xu Yunfeng;Tong Yiru(Department of Ultrasonography,Shanghai Children's Hospital,Shanghai 200062,China;Department of Anesthesia&Surgery,Shanghai Children's Hospital,Shanghai 200062,China)

机构地区：[1]上海市儿童医院超声科,上海市200062 [2]上海市儿童医院麻醉手术科,上海市200062

出　　处：《临床小儿外科杂志》2021年第5期464-468,共5页Journal of Clinical Pediatric Surgery

基　　金：上海交通大学“交大之星”计划医工交叉研究基金项目(编号:YG2021QN114)。

摘　　要：目的探讨彩色多普勒超声对儿童鳃裂畸形的诊断价值。方法以上海市儿童医院2016年1月至2020年12月通过超声检查发现疑似鳃裂畸形并接受手术治疗的75例患者为研究对象,对其超声图像特征进行总结分析。结果75例初次出现症状的年龄为(4.17±2.99)岁,行超声检查时年龄为(5.43±3.26)岁。术后确诊鳃裂畸形70例、颈部错构瘤5例。所有鳃裂畸形定位准确(70/70,100.0%),与术后诊断相符者52例,其中第一鳃裂畸形10例(10/70,14.3%),包括囊肿1例、瘘管7例、囊肿并瘘管2例;第二鳃裂畸形7例(7/70,10.0%),包括囊肿2例、瘘管5例;梨状窝瘘53例(53/70,75.7%),其中35例与术后诊断相符,18例误诊(9例误诊为甲状腺炎,5例误诊为甲状腺旁窦道,2例误诊为甲状腺旁单房囊肿,1例误诊为淋巴管瘤,1例误诊为甲状腺外侧囊肿)。5例错构瘤术前超声均误诊为第二鳃裂瘘管。鳃裂瘘管表现为条状低回声或不规则混合回声向体表或深层延伸;梨状窝瘘表现多样,并向后上方延伸呈“L”形或向周围破溃呈“J”形,内含气体高回声时可高度提示梨状窝瘘。结论超声可准确显示儿童鳃裂畸形的声像图特征及走行,可根据其典型位置和声像图特征与其它相关疾病进行鉴别,有利于鳃裂畸形的临床诊断及治疗。Objective To explore the diagnostic value of color Doppler ultrasound in branchial cleft deformity in children.Methods From January 2016 to December 2020,retrospective analysis was performed for 75 children with suspected branchial cleft deformity undergoing ultrasound examination and surgery.The surgical outcomes were compared and the ultrasonic findings summarized.Results The onset age of symptoms was(4.17±2.99)years and the age of ultrasonic examination(5.43±3.26)years.Branchial cleft deformity(n=70)and cervical hamartoma(n=5)were confirmed postoperatively.There were 10 cases(10/70,14.3%)of the first branchial cleft deformity,including cyst(n=1),fistula(n=7)and cyst&fistula(n=2);7 cases(7/70,10%)of the second branchial cleft deformity,including cyst(n=2)and fistula(n=5).All of them were consistent with the postoperative diagnosis.Among 53 cases(53/70,75.7%)of pyriform fossa fistula,35 cases were consistent with the postoperative diagnosis.Among 18 misdiagnosed cases,the misdiagnoses were thyroiditis(n=9),parathyroid sinus(n=5),parathyroid unicameral cyst(n=2),lymphangioma(n=1)and lateral thyroid cyst(n=1).And ultrasonic misdiagnoses included diagnosed hamartoma as the second branchial fistula(n=5)and pyriform sinus fistula(n=18).The branchial cleft cysts displayed irregular or oval shape,anechoic or hypoechoic,no blood flow signal;branchial cleft fistulas showed strip-shaped low echo or irregular mixed echo extending to the superficial or deep.The manifestations of pyriform sinus fistula were diverse,showing unilateral thyroiditis and extending backward or upward in the shape of“L”or the surrounding burst like“J”or high echo with gas,it hinted at pyriform sinus fistula.Conclusion Ultrasound can accurately depict the sonographic features and shape of branchial cleft deformity in children and distinguishes it from other related diseases according to its typical locations and sonographic features.It is conducive to the clinical diagnosis and treatment of branchial cleft deformity.

关 键 词：鳃区/畸形 超声检查 多普勒 彩色 诊断 儿童 

分 类 号：R445.1[医药卫生—影像医学与核医学] R729[医药卫生—诊断学]