超声结合生理盐水灌肠检查对小儿肠壁增厚性病变的诊断价值

摘要/Abstract

摘要： 目的探讨与分析超声结合生理盐水灌肠检查对小儿肠壁增厚性病变的诊断价值。方法选择2019年2月~2022年2月在宁夏医科大学总医院诊治的肠壁增厚性病变患儿70例作为研究对象,所有患儿都给予超声结合生理盐水灌肠检查,记录影像学特征。以内镜病理检查作为金标准,重点记录肠套叠与肠坏死情况,将患儿分为肠套叠组（38例）与肠坏死组（32例）。对比肠套叠与肠坏死两组超声特征（肠壁积气,“翻滚征”“葡萄串征”“蟹足征”）,生理盐水灌肠复位水压,超声血流分级（Ⅰ级、Ⅱ级、Ⅲ级）,诊断价值与内镜病理检查的一致性分析。结果肠套叠组中患儿表现为肠壁增厚,肠套叠组的肠壁积气、“翻滚征”“葡萄串征”“蟹足征”占比分别为73.68%、81.58%、84.21%、81.58%,均明显高于肠坏死组的50%、56.25%、62.5%、59.38%,对比差异有统计学意义（P<0.05）。肠坏死组的生理盐水灌肠复位水压明显低于肠套叠组（P<0.05）。肠套叠组超声血流分级为Ⅰ级30例、Ⅱ级5例、Ⅲ级3例;肠坏死组分别为Ⅰ级12例、Ⅱ级10例、Ⅲ级10例,两两对比差异有统计学意义（P<0.05）。在70例患儿中,超声结合生理盐水灌肠检查判断为肠套叠39例,肠坏死31例,为此超声结合生理盐水灌肠检查对小儿肠壁增厚性病变的诊断敏感性与特异性分别为100%和96.88%,与内镜病理检查一致性检验的统计量Kappa=0.971（P<0.001）。结论小儿肠壁增厚性病变以肠套叠与肠坏死为主,两者的超声特征与血流特征存在差异,同时生理盐水灌肠复位水压也存在差异,超声结合生理盐水灌肠检查对小儿肠壁增厚性病变的诊断具有很高的敏感性与特异性,且与内镜病理检查结果具有高度一致性。

关键词: 超声, 生理盐水灌肠, 小儿, 肠壁增厚性病变, 肠套叠, 肠坏死

Abstract: Objective To explore and analysis the diagnostic values of ultrasound combined with normal saline enema in children with intestinal wall thickening lesions. Methods From February 2019 to February 2022, 70 cases of children with intestinal wall thickening lesions who were diagnosed and treated in our hospital were selected as the research subjects. All children were given ultrasound combined with normal saline enema examination, and the imaging characteristics were recorded. With endoscopic pathology as the gold standard, intussusception and intestinal necrosis were mainly recorded. The children were divided into intussusception group (38 cases) and intestinal necrosis group (32 cases). The ultrasonic characteristics (intestinal wall gas accumulation, “rolling sign”, “grape cluster sign”, “crab foot sign”), pressure of normal saline enema reduction, and ultrasonic blood flow classification (grade I, grade II, grade III)were compared between intussusception and intestinal necrosis groups. Results In the 70 children, there were 38 cases of intussusception (intussusception group) and 32 cases of intestinal necrosis (intestinal necrosis group) were determined by endoscopy. All the children were showed thickening of the intestinal wall, and the intestinal wall gas, “rolling sign”, “grape bunch sign” and “crab foot sign” in the intussusception group accounted for 73.68%, 81.58%, 84.21%, 81.58%, which were significantly higher than 50.00%, 56.25%, 62.50%, 59.38% of the intestinal necrosis group, the difference is statistically significant (P<0.05). The normal saline enema reduction water pressure in the intestinal necrosis group was significantly lower than that in the intussusception group, the difference is statistically significant (P<0.05). In the intussusception group, there were 30 cases were grade I, 5 cases were grade II, and 3 cases were grade III; in the intestinal necrosis group, there were 12 cases, 10 cases, and 10 cases, respectively, and there were significant differences compared between the two groups, the difference is statistically significant (P<0.05). In the 70 children, there were 39 cases of intussusception and 31 cases of intestinal necrosis were judged by ultrasound combined with normal saline enema. Therefore, the sensitivity and specificity of ultrasound combined with normal saline enema in the diagnosis of intestinal wall thickening lesions in children were respectively were 100% and 96.88%, the Kappa value of consistency test with endoscopic pathological examination was 0.971 (P<0.001). Conclusion Intussusception and intestinal necrosis are the main lesions of intestinal wall thickening in children. The ultrasound characteristics and blood flow characteristics of the two are different. At the same time, there are also differences in the water pressure of normal saline enema. The diagnosis of intestinal wall thickening lesions has high sensitivity and specificity, and the results are highly consistent with endoscopic pathological examination.

Key words: ultrasound, saline enema, children, intestinal wall thickening lesions, intussusception, intestinal necrosis

中图分类号:

R445.1

柴佩, 米成嵘. 超声结合生理盐水灌肠检查对小儿肠壁增厚性病变的诊断价值[J]. 中华养生保健, 2022, 40(24): 52-55.

CHAI Pei, MI Cheng-rong. The Diagnostic Values of Ultrasound Combined with Normal Saline Enema in Children with Intestinal Wall Thickening Lesions[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(24): 52-55.

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