高频超声对新生儿食道闭锁的诊断及术前评估  

High-Frequency Ultrasound for Diagnosis and Preoperative Evaluation of Neonatal Esophageal Atresia

作　　者：陈天兵 杨弋仙 曾祥勇 黄金狮[3] 陈快[3] 赵春晓[5] 彭晓卫[1] 袁蔡晖 CHEN Tian-bing;YANG Yi-xian;ZENG Xiang-yong;HUANG Jin-shi;CHEN Kuai;ZHAO Chun-xiao;PENG Xiao-wei;YUAN Cai-hui(Department of Ultrasound,Jiangxi Children’s Hospital;Department of Emergency,Jiangxi Children’s Hospital;Department of Neonatal Surgery,Jiangxi Children’s Hospital;Department of Radiology,Jiangxi Children’s Hospital;Department of Ultrasound,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]江西省儿童医院超声科 [2]江西省儿童医院急诊科 [3]江西省儿童医院新生儿外科 [4]江西省儿童医院放射科 [5]南昌大学第一附属医院超声科,南昌330006

出　　处：《南昌大学学报（医学版）》2023年第3期44-47,共4页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫健委科技计划(202130929)。

摘　　要：目的探讨高频超声用于诊断新生儿食道闭锁的临床价值。方法选取2020年1月至2022年3月于江西省儿童医院新生儿外科经手术确诊的59例食道闭锁患儿。回顾性分析其临床资料,包括术前X线食道造影、高频超声测量与术中诊断情况等。结果59例患儿中,48例高频超声见闭锁食道近段盲端呈积液膨大,大致在T2—T4水平;9例经胃管注入气液混合物5 mL显示膨大的食道闭锁盲端;位置均与X线食道造影显示一致。漏诊误诊:因食道较完整,2例单发食管-气管瘘术前漏诊,术后均诊断为Ⅴ型食道闭锁;1例远端瘘口误诊,术前诊断为ⅢB型,术后诊断为Ⅳ型;59例患儿术前超声确诊率为94.9%(56/59)。高频超声分型和术中分型比较差异无统计学意义(P>0.05),高频超声测量食道闭锁两盲端距离与术中测量结果比较差异无统计学意义(P>0.05)。结论高频超声探查对新生儿食道闭锁的确诊率较高,且对食道闭锁分型和盲端测距较X线食道造影优势明显。高频超声探查可完善术前方案并提供可靠的盲端距离,极大地降低了手术风险。Objective To explore the clinical value of high-frequency ultrasound in the diagnosis of neonatal esophageal atresia.Methods Clinical data of 59 neonates who were diagnosed with esophageal atresia by surgery from January 2020 to March 2022 in the Department of Neonatal Surgery of Jiangxi Children’s Hospital were retrospectively analyzed,including preoperative X-ray esophagography,high-frequency ultrasonic measurement and intraoperative diagnosis.Results Among the 59 cases,48 had hydrops at the proximal blind end of the occluded esophagus(T2-T4),which were consistently located in the position shown by X-ray esophagography.In 9 cases,the enlarged blind end of the occluded esophagus was observed by injecting 5 mL of gas-liquid mixture through gastric tube,and showed consistent location with that displayed by X-ray esophagography.Because the esophagus was relatively complete,2 cases of single esophagotracheal fistula were missed before operation,but were diagnosed as typeⅤesophageal atresia after operation.One case of distal fistula was misdiagnosed,which was diagnosed as typeⅢB before operation and typeⅣafter operation.The preoperative ultrasound diagnosis rate was 94.9%(56/59).The high-frequency ultrasound classification was not statistically different from the intraoperative classification(P>0.05).In addition,the distance between the two blind ends of esophageal atresia measured by high-frequency ultrasound was not significantly different from that measured during operation(P>0.05).Conclusion High-frequency ultrasound has a high diagnostic rate for neonatal esophageal atresia.with X-ray esophagography,high-frequency ultrasound has obvious advantages in esophageal atresia classification and blind end distance measurement.It can improve the surgeon’s preoperative plan and provide reliable blind end distance,greatly reducing the risk of neonatal surgery.

关 键 词：食道闭锁 新生儿 超声诊断 X线食道造影 分型 盲端测距 

分 类 号：R722.1[医药卫生—儿科] R445.1[医药卫生—临床医学]