超声诊断新生儿坏死性小肠结肠炎的临床价值

目的探讨超声检查(ultrasonography,US)在新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)中的诊断价值。方法分析2010年1月至2011年10月我院65例NEC患儿超声图像特征,并与X线平片检查结果相对比。结果 65例NEC患儿中80.0%(52/65)的患儿声像图表现为多发肠壁增厚,增厚部位以小肠为主,小肠壁厚度均﹥3 mm,并可伴腹腔积液征象;41例可见肠壁积气,其中49.2%(32/65)于肠壁黏膜下可见点状或颗粒状气体回声,13.8%(9/65)浆膜下可见线状或短条状样高回声;23.1%的患儿(15/65)可见门静脉积气,超声表现为门静脉主干或分支内呈现气泡样或串珠样高回声光点,和(或)肝实质内门静脉分支内高回声光斑或条片状高回声区。US对肠壁积气检出的阳性率高于X线平片(P<0.05)。结论 US在NEC早期诊断及随访监测中具有重要临床应用价值。

Ultrasonography in diagnosis of neonatal necrotizing enterocolitis

Objective To evaluate the diagnostic value of ultrasonography for neonatal necrotizing enterocolitis(NEC).Methods Clinical data of 65 cases(at an age from 3 h to 30 d) diagnosed as NEC in our hospital from January 2010 to October 2011 were collected in this study.Findings of ultrasonography was analyzed and compared with those of X-ray plain film.Results Ultrasonography displayed that there were multiple bowel wall thickening observed with in 52 cases(80.0%),mainly in small intestine(with average thickness over 3 mm) and accompanying with seroperitoneum.Intestinal wall pneumatosis were found in 41 cases.Echogenic dots or granular gas echogenicities were found under bowel mucosa in 32 cases(49.2%),linear or bar-like hyperecho was found under the serosa in 9 cases(13.8%).There were 15 cases with portal vein pneumatosis observed with ultrasonography,with bubble or beadlike hyperecho in the main truck or branches of portal vein,and/or spot or striped hyperechoic area in portal vein branches in the liver parenchyma.Ultrasonography had a higher positive rate to intestinal wall pneumatosis than X-ray plain film(P<0.05).Conclusion Ultrasonography play an important role in early diagnosis and follow-up monitoring for NEC.