超声检查对新生儿坏死性小肠结肠炎手术决策的意义探讨  

Role of ultrasound in surgical decision making for neonatal necrotizing enterocolitis

作　　者：马亚 王峥嵘[1] 刘琴[1] 张薇薇[1] 任红雁[1] Ma Ya;Wang Zhengrong;Liu Qin;Zhang Weiwei;Ren Hongyan(Department of Ultrasonography,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所超声科,北京100020

出　　处：《临床小儿外科杂志》2022年第4期325-330,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的通过分析新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)患儿肠壁形态、血流分布及肠道蠕动的腹部超声声像特征,探讨超声检查对于NEC手术决策的意义。方法回顾性收集2017年9月至2020年3月首都儿科研究所收治的NEC患儿临床资料以及超声声像图,按照治疗方法的不同分为保守治疗组和手术治疗组,比较分析两组患儿超声声像特征。结果共收治NEC患儿45例,其中保守治疗30例,为保守治疗组;手术治疗15例,为手术治疗组。两组超声声像图比较,手术治疗组肠壁变薄[(53.3%(8/15)比0%]、肠壁分层消失[100%(15/15)比16.7%(5/30)]、肠壁血流信号消失[73.3%(11/15)比0%]、肠管蠕动消失[93.3%(14/15)比33.3%(10/30)]、肠管扩张[46.7%(7/15)比3.3%(1/30)]、透声差的积液[80%(12/15)比0%]发生率高于保守治疗组,差异均有统计学意义(P<0.05)。而两组肠壁增厚[86.7%(13/15)比60%(18/30)]、肠壁积气[73.3%(11/15)比70%(21/30)]、肠壁血流信号丰富[20%(3/15)比13.3%(4/30)]、肠管狭窄[20%(3/15)比0%]、门脉积气[13.3%(2/15)比20%(6/30)]的发生率差异无统计学意义(P>0.05)。在指导NEC手术决策上,超声检查发现透声差的积液(Kappa值=0.69,P<0.001)、肠壁血流信号消失(Kappa值=0.62,P=0.01)两项指征与诊断性腹腔穿刺的结论有较好的一致性。对超声征象进行两两组合发现,肠管蠕动消失与肠壁分层消失组合用于预测NEC手术时机,可获得较高的敏感度(93.3%)和特异度(93.3%)。结论对肠道进行形态、血流分布、肠蠕动特点和肠道外间接征象的综合超声分析,有利于早期识别NEC危重症,可为手术时机的判断提供新的参考依据。Objective To explore the clinical value of ultrasonography(US)in surgical decision making in infants with neonatal necrotizing enterocolitis(NEC)by assessing morphological characteristics,vascularity and peristalsis of bowel wall of abdominal US imaging.Methods From September 2017 to March 2020,US findings and other clinical data were retrospectively analyzed for 45 hospitalized NEC children undergoing US examination.They were assigned into non-surgical(n=30)and surgical(n=15)groups.And the inter-group differences of sonographic features were assessed.Results As compared with non-surgical group,surgical group had higher proportions of bowel wall thinning[53.3%(8/15)vs.0%],loss of stratification of bowel wall[100%(15/15)vs.16.7%(5/30)],absence of bowel wall vascularization[73.3%(11/15)vs.0%],absence of peristalsis[93.3%(14/15)vs.33.3%(10/30)]and echogenic free fluid[80%(12/15)vs.0%].The differences were statistically significant(P<0.05).Two groups did not differ significantly in terms of bowel wall thickening[86.7%(13/15)vs.60%(18/30)],pneumatosis intestinalis[73.3%(11/15)vs.70%(21/30)],hypervascularity of affected bowel[20%(3/15)vs.13.3%(4/30)],bowel stenosis[20%(3/15)vs.0%]or portal venous gas[13.3%(2/15)vs.20%(6/30)](P>0.05).Consistency analysis showed echogenic free fluid and absence of bowel wall vascularization on US images had a good agreement with diagnostic abdominal paracentesis for surgical decision making(Kappa value=0.69,P<0.001;Kappa value=0.62,P=0.01).Combinations of two of those parameters indicated that the combination of absence of peristalsis and loss of stratification of bowel wall offered a better profile of sensitivity(93.3%)and specificity(93.3%).Conclusion Comprehensive analysis of bowel morphological character,blood perfusion and peristaltic activity on US might help identify the critical status of NEC and provide valuable information on surgical decision making.

关 键 词：小肠结肠炎 坏死性/诊断 小肠结肠炎 坏死性/外科学 超声检查 婴儿 新生 病例对照研究 

分 类 号：R722.1[医药卫生—儿科]