新生儿肠闭锁的超声诊断价值及漏误诊分析  

Ultrasound diagnostic value and misdiagnosis,missed diagnosis of neonatal intestinal atresia

作　　者：郭丹阳[1] 吴明君 刘畅[1] 董丽楠 陈明伟[2] GUO Dan-yang;WU Ming-jun;LIU Chang;DONG Li-nan;CHEN Ming-wei(Department of Ultrasound,The Sixth Affiliated Hospital of Harbin Medical University(Harbin Children's Hospital),Harbin 150010,China;Department of Anatomy,Harbin Medical University,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第六医院(哈尔滨市儿童医院)超声科,黑龙江哈尔滨150010 [2]哈尔滨医科大学解剖学教研室,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2022年第4期353-356,共4页Journal of Harbin Medical University

基　　金：黑龙江省博士后科研启动基金项目(LBH-Z17128)。

摘　　要：目的探讨超声检查在新生儿肠闭锁诊断中的价值,分析漏、误诊原因,观察肠闭锁超声解剖学特征。方法对哈尔滨市儿童医院2018年6月~2021年10月经手术证实的新生儿肠闭锁的48例患儿进行回顾性分析。由贲门至结直肠顺序探查,判定梗阻点,对超声解剖学要点、声像图特征进行分析。结果超声诊断肠闭锁的总符合率为87.5%(42/48)。肠道合并症:穿孔并胎粪性腹膜炎2例,肠扭转并胎粪性腹膜炎7例,肠旋转不良2例,肠系膜及血管发育不良3例,肠套叠1例,肠系膜囊肿1例,肠重复畸形1例,美克尔憩室2例。空肠闭锁患儿扩张肠管内容物为细小点状回声占66.7%(6/9),回肠闭锁患儿扩张肠管内容物在超声下为粗大点状回声占65.6%(21/32),两组之间比较差异无统计学意义(P>0.05),但随着闭锁位置的降低,肠内容物黏稠度逐渐增加。结论超声检查已成为诊断新生儿肠闭锁的重要检查方法,可为外科手术方案的制定提供有力的依据。Objective To explore the value of ultrasound in the diagnosis of neonatal intestinal atresia and analyze the causes of missed diagnosis and misdiagnosis,and to observe the anatomical features of intestinal atresia.Methods Forty-eight children with neonatal intestinal atresia confirmed by surgery in The Sixth Affiliated Hospital of Harbin Medical University(Harbin Children’s Hospital)from June 2018 to October 2021 were retrospectively analyzed.Ultrasound examination was performed sequentially from the cardia to the colorectum to determine the obstruction point,and the ultrasonic anatomical points and sonographic features were analyzed.Results The overall coincidence rate of ultrasound diagnosis of intestinal atresia was 87.5%(42/48).Intestinal complications were including 2 cases of perforation with meconium peritonitis,7 cases of volvulus with meconium peritonitis,2 cases of intestinal dysrotation,3 cases of mesenteric and vascular dysplasia,1 case of intussusception,1 case of mesenteric cyst,1 case of intestinal duplication and 2 cases of Meckel’s diverticulum.In this group of cases,the contents of dilated bowel in 66.7%(6/9)children with jejunal atresia were small punctate echoes,the contents of dilated bowel in 65.6%(21/32)children with ileal atresia were large patch echoes.The difference was not statistically significant(P>0.05),but it can be found that as the atresia position decreased,the viscosity of the intestinal contents gradually increased.Conclusion Ultrasound has become an important examination method for the diagnosis of neonatal intestinal atresia and provides a strong basis for the formulation of surgical procedures.

关 键 词：超声检查 解剖学 肠闭锁 新生儿 

分 类 号：R722.1[医药卫生—儿科]