超声检查对新生患儿肥厚性幽门狭窄和幽门痉挛的鉴别诊断分析

目的：探讨超声检查对于鉴别诊断肥厚性幽门狭窄（ CHPS）患儿与幽门痉挛患儿的临床价值。方法选取2014年2月至2016年3月在成都医学院第一附属医院手术治疗的41例CHPS患儿（ CHPS组）、40例临床确诊的幽门痉挛患儿（幽门痉挛组）、20例正常新生儿作为对照组，对各组新生儿进行幽门部超声检查，对比各组新生儿的超声幽门管长度、幽门环肌厚度，并以临床最终结果作为金标准计算超声鉴别诊断CHPS患儿与幽门痉挛患儿的诊断学效能指标。结果 CHPS组患儿的幽门管长度、幽门环肌厚度超声测定值均显著的高于幽门痉挛组、对照组新生儿，差异均具有统计学意义（与幽门痉挛组比较t值分别为13．827和15．033，与对照组新生儿比较t值分别为18．726和22．049，均P＜0．05）；幽门痉挛组患儿的幽门管长度、幽门环肌厚度超声测定值显著的高于对照组新生儿，差异具有统计学意义（ t值分别为3．391和5．510，均P＜0．05）；CHPS组患儿的幽门管长度、幽门环肌厚度超声测定值与手术中测定值比较差异均无统计学意义（t值分别为0．740和1．301，均P＞0．05）；超声鉴别诊断CHPS患儿与幽门痉挛患儿的灵敏度为95．12％、特异度为92．50％、漏诊率为4．88％、误诊率为7．50％、超声诊断结果与最终确诊结果的一致性（kappa＝0．876，P＜0．05）。结论超声检查对于鉴别诊断CHPS患儿与幽门痉挛患儿具有较高的临床价值。

Differential diagnosis of congenital hypertrophic pyloric stenosis and pylorospasm by ultrasonography

Objective To investigate the clinical value of ultrasonography in the differential diagnosis of congenital hypertrophic pyloric stenosis ( CHPS) and pylorospasm.Methods Forty-one CHPS children ( CHPS group) , 40 children clinically diagnosed with pylorospasm ( pylorospasm group) who received surgery in the First Affiliated Hospital of Chengdu Medical College from February 2014 to March 2016, and 20 cases of normal newborns ( control group) were selected.Pylorus ultrasound examinations were conducted among the three groups of neonates to compare their ultrasound pyloric tube length and pyloric ring muscle thickness.With the final clinical results serving as a golden standard, the diagnostic effectiveness index of ultrasound in differentially diagnosing CHPS children and pyloriospasm in children were calculated.Results The pyloric tube length and pyloric ring muscle thickness in CHPS group were significantly higher than those in pylorospasm group and the control group, and the differences were statistically significant ( compared to the pylorospasm group, t value was 13.827 and 15.033 respectively;compared to the control group,t value was 18.726 and 22.049 respectively, all P<0.05).Pyloric pipe length and pyloric ring muscle thickness of pylorospasm group were significantly higher than those of the control group, and the differences were statistically significant (t value was 3.391 and 5.510 respectively, both P<0.05).Ultrasound measured values of pyloric pipe length and pyloric ring thickness of CHPS group were not statistically different from the measured value of surgery (t value was 0.740 and 1.301 respectively, both P>0.05).The sensitivity of ultrasound in differential diagnosing CHPS patients and pylorospasm patients was 95.12%, the specificity was 92.50%, the misdiagnosis rate was 7.50%, the missed diagnosis rate was 4.88%, and the kappa value was 0.876 (all P<0.05).Conclusion Ultrasound examination is of high clinical value for the differential diagnosis of CHPS and pylorospasm in children.