高频超声及超声造影引导内镜治疗小儿粪石所致化脓性阑尾炎的临床价值  

Clinical value of high frequency ultrasound and contrast-enhanced ultrasound-guided endoscopic in the treatment of suppurative appendicitis caused by fecalith in children

作　　者：郭晓亚 杨恒丽 李菁华 杨一林 曾令超 王春晖 杨瑞静 GUO Xiaoya;YANG Hengi;LI Jinghua;YANG Yiin;ZENG Lingchao;WANG Chunhui;YANG Ruijing(Department of Ultrasound,the Second Affiliated Hospital,Air Force Military Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学第二附属医院超声科,西安市710038 [2]空军军医大学第二附属医院儿科,西安市710038 [3]西安医学院第二附属医院超声科

出　　处：《临床超声医学杂志》2024年第7期564-568,共5页Journal of Clinical Ultrasound in Medicine

基　　金：空军军医大学第二附属医院科技创新发展基金(2019LCYJ007)。

摘　　要：目的探讨高频超声及术中腔内超声造影引导内镜下逆行阑尾炎治疗术(ERAT)联合数字化胆道子镜(以下简称子镜)治疗小儿粪石所致化脓性阑尾炎的临床价值。方法回顾性分析行内镜治疗的48例粪石所致化脓性阑尾炎患儿的病历资料,所有患儿术前均行高频超声检查测量阑尾外径、阑尾壁厚度、粪石直径,观察其周边网膜是否增厚,术中腔内超声造影观察并记录粪石是否成功取出、阑尾有无穿孔。根据术后治疗结果分为取石成功组39例和术中穿孔组9例,分析超声与子镜检查结果的诊断符合率;记录并发症发生情况。治疗后定期随访患儿,比较两组超声参数、实验室指标恢复正常时间和临床症状消失时间及疗效。结果48例患儿术中腔内超声造影显示粪石成功清除39例,阑尾穿孔9例;子镜显示粪石成功清除34例,阑尾破口5例,二者诊断符合率分别为87.17%、55.56%。术后取石成功组均未见明显并发症,术中穿孔组出现1例阑尾周围包裹性脓肿。治疗后两组阑尾壁厚度、网膜厚度、白细胞计数、C反应蛋白恢复正常参考值时间和腹痛、发热消失时间比较,差异均有统计学意义(均P<0.05)。取石成功组疗效为优、良、差者分别为35、4、0例,术中穿孔组疗效为优、良、差者分别为0、8、1例,两组治疗优良率比较(100%vs.88.89%),差异无统计学意义。结论高频超声及术中腔内超声造影引导ERAT联合子镜治疗小儿粪石所致化脓性阑尾炎具有实时、精准、治愈率高且并发症少的优势,有一定的临床价值。Objective To explore the clinical value of high frequency ultrasound and intraoperative contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis therapy(ERAT)combined with digital cholangioscopy in the treatment of pediatric suppurative appendicitis caused by fecalith in children.Methods Retrospective analysis of endoscopic treatment history of 48 children with suppurative appendicitis caused by fecalith was performed.Preoperatively,high-frequency ultrasound was performed to measure the outer diameter of the appendix,the thickness of the appendix wall and the diameter of the fecalith,and observe whether the surrounding omentum was thickened.Intraoperatively,intraoperative contrast-enhanced ultrasound was used to observe and record whether the fecalith was removed successfully and whether the appendix was perforated.According to the treatment results,39 cases in successful fecaliths removal group and 9 cases in intraoperative perforation group were divided.The coincidence rate between ultrasound and digital cholangioscopy was analyzed,and the occurence of complications was recorded.After treatment,the children were regularly followed up.Ultrasound parameters,clinical symptoms,and laboratory indicators were compared between the two groups.Results In 48 children,intraoperative contrast-enhanced ultrasound showed that fecaliths were successfully removed in 39 cases,and appendiceal perforation occurred in 9 cases.Digital cholangioscopy showed that fecaliths were successfully removed in 34 cases,and appendix rupture in 5 cases.The concordance rates between the two modalities were 87.17%and 55.56%,respectively.No significant complications were observed in the successful fecaliths removal group,1 case of periappendiceal encapsulated abscess occurred in the intraoperative perforation group.There were significant differences between the two groups in appendix wall thickness and omentum thickness returned to normal reference time,disappearance time of abdominal pain and fever,and normal time of white blood cel

关 键 词：超声检查 造影剂 化脓性阑尾炎 粪石 内镜治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学]