扇形超声显像对输尿管梗阻性疾病的诊断价值

采用扇形超声显像诊断输尿管梗阻性疾病收到了较好的效果，其中扇形超声诊断输尿管梗阻位置的符合率为９４．９％（７４／７８），诊断输尿管梗阻病因的符合率为９１％（７１／７８）。扇形超声较线阵式超声操作更为灵活和轻便，尤其对过于肥胖、受胃肠道气体或粪团干扰较重的患者，扇形超声能弥补线阵式超声检查的许多不足，可做为诊断输尿管梗阻性疾病的首选方法之一。     

高频超声联合胃肠充盈法诊断小儿先天性十二指肠梗阻性疾病的价值北大核心CSCD

目的探讨高频彩色多普勒超声联合胃肠充盈法对小儿先天性十二指肠梗阻性疾病的诊断价值。方法对100例临床怀疑十二指肠梗阻患儿行胃肠道超声及上消化道造影检查,以手术结果作为金标准,比较超声与上消化道造影在诊断小儿先天性十二指肠梗阻中的价值。结果超声与上消化道造影对十二指肠梗阻诊断准确率分别为100％、94％,差异有统计学意义（P=0．041）;梗阻定位准确率分别为98．04％、84．31％,差异有统计学意义（P=0．023）;对导致十二指肠梗阻的先天性疾病总诊断准确率分别为89％、49％,差异有统计学意义（P=0．001）。结论高频超声联合胃肠充盈法对小儿先天性十二指肠梗阻性疾病具有较高的诊断准确率,对某些疾病的诊断优于上消化道造影。     

超声引导经皮肾盂穿刺造影对非结石输尿管梗阻的诊断应用价值

目的：探讨经皮肾穿刺造影对非结石性输尿管梗阻疾病的诊断价值。方法：应用超声和超声引导经皮肾穿刺造影检查３１例中重度肾积水患者,并与手术病理对照。结果：超声诊断符合率为６４．５％（２０／３１）,不符合率为３５．５％（１１／３１）．超声引导经皮肾盂穿刺造影符合率为９３．５％（２９／３１）,不符合率为６．５％（２／３１）。穿刺造影诊断符合率显著高于超声检查法,ｐ＜０．０５。结论：超声引导下经皮肾盂穿刺造影可以提高上尿路梗阻疾病病因及定位诊断符合率,操作简便,安全,弥补了ＩＶＰ和超声检查的不足,是一种明确中重度肾积水病因和梗阻部位的可靠诊断方法。     

经阴道/直肠超声诊断输尿管下段梗阻的临床应用

目的探讨经阴道／直肠超声(TVS／TRS)诊断输尿管下段梗阻性病变的应用价值。方法对疑为输尿管下段梗阻的31例患者行经阴道／直肠超声检查。结果31例患者中，输尿管梗阻病变检出率100％，诊断符合率96．8％。结论应用经阴道／直肠超声检查可以快速、简捷、准确地诊断输尿管下段梗阻性病变．具有较高的临床应用价值。     

B超诊断上消化道梗阻性疾病及与X线钡餐检查对比研究

目的：探讨Ｂ超诊断上消化道梗阻性疾病的临床价值并与Ｘ线钡餐检查（ＧＩ）比较。方法：Ｂ超检查４５例，ＧＩ检查３１例，全部经手术病理证实。结果：Ｂ超判断有无梗阻符合率９５．５％、特异性９７．８％、敏感性９７．８％，ＧＩ分别为９０．３％、１００．０％及９０．３％（Ｐ＞０．０５）。Ｂ超判断梗阻部位符合率为９５．５％，ＧＩ为９６．４％（Ｐ＞０．０５）。在判断有无梗阻及梗阻部位方面两者准确性相近。Ｂ超对梗阻原因符合率为８２．２％，ＧＩ为５１．６％（Ｐ＜０．０１）。结论：Ｂ超同样是诊断上消化道梗阻性疾病的有效手段，病因诊断优于ＧＩ，且安全、无创、重复性强，对于儿童病例更具优越性。     

MRCP与ERCP对胆道梗阻性疾病诊断价值的比较

目的 比较磁共振胰胆管成像（MRCP）和内镜下逆行胰胆管造影术（ERCP）在胆道梗阻性疾病中的诊断价值。方法收集MRCP及ERCP资料完整经临床证实的胆道梗阻性疾病患者101例，结果进行对照分析。结果101例胆道梗阻性疾病患者，MRCP总符合率92．1％，ERCP总符合率98％，两者在统计学上无显著差异。结论MRCP作为无创性检查，可作为胆道梗阻性疾病诊断的首选方法，但ERCP可同时进行经内镜下治疗，MRCP不能完全取代ERCP，两者结合互补，可进一步提高对胆道梗阻性疾病的诊断准确率。     

超声引导经皮肾盂穿造影对非结石输尿管梗阻的诊断应用价值

目的：探讨经皮肾穿刺造影对非结石性输尿管梗阻疾病的诊断价值。方法：应用超声和超声引导经皮肾穿刺造影检查３１例中重度肾积水患者,并与手术病理对照。结果：超声诊断符合率为６４．５％（２０／３１）,不符合率为３５．５％（１１／３１）,超声引导经皮肾盂穿刺造影符合率为９３．５％（２９／３１）,不符合率为６．５％（２／３１）。穿刺造影诊断符合率显著高于超声检查法,Ｐ〈０．０５。结论：超声引导下经皮肾盂穿刺造     

超声在肝外胆管梗阻病因中的诊断分析

目的：探讨超声对肝外胆管梗阻性疾病的病因诊断价值。材料与方法：对我院2004—2008年收治并手术的91例肝外胆管梗阻性疾病患者的超声声像图进行回顾性分析和总结,并与手术病理结果对比分析,总结不同病因引起肝外胆管梗阻的超声影像特点,从而提高超声诊断率。结果：91例肝外胆管梗阻性疾病患者的超声病因诊断总符合率89.0%（81/91）,其中胆管结石符合率94.7%（54/57）,胰腺炎符合率66.7%（2/3）,胆管炎符合率66.7%（2/3）,胰头癌符合率84.6%（11/13）,壶腹部癌符合率81.8%（9/11）,胆管癌符合率75%（3/4）。误诊10例（10.9%）,分别为胆管结石3例,胰腺炎与胆管炎各1例,胰头癌与壶腹部癌各2例,胆管癌1例。结论：超声对肝外胆管梗阻的病因诊断与手术病理结果符合率高,具有较高的病因诊断价值,可作为肝外胆管梗阻性疾病检查的首选方法。     

低场MRCP结合常规MRI在胆道梗阻性疾病诊断中的临床应用

目的评价低场磁共振胆胰管成像（MRCP）结合常规磁共振成像（MRI）对胆道梗阻性疾病的诊断价值。方法回顾性分析38例经手术或临床证实的胆道梗阻性疾病患者的低场（0．2T）MRCP及常规MRI图像。结果低场MRCP结合常规MRI对胆道梗阻性疾病的定位诊断符合率为100％，定性诊断总符合率为84．2％。结论低场MRCP结合常规MRI对胆道梗阻性疾病的诊断是非常有效和准确的方法。     

超声检查和核素显像对亚急性甲状腺炎的诊断价值

目的探讨超声检查和核素显像在亚急性甲状腺炎的临床诊断价值。方法对98例亚急性甲状腺炎的超声检查和核素显像资料进行分析。结果98例超声检查诊断符合率86．73％,核素显像诊断符合率90．82％,超声检查和核素显像两者结合诊断符合率100％。结论超声和核素显像联合检查在亚急性甲状腺炎的诊断中可减少漏诊及误诊率,提高诊断符合率。     

上尿路梗阻影像学诊断的临床价值

目的:探讨和评价影像学检查对上尿路梗阻性病变的诊断价值。方法:回顾性分析120例上尿路梗阻病例的临床资料,重点分析比较B超(B-US)、静脉肾盂造影(IVP)、CT和磁共振尿路造影(MRU)对上尿路梗阻的定位、定性诊断中的作用。结果:B-US、IVP、CT和MRU对上尿路梗阻定位正确率分别为65.8%,88.6%,85.7%和92.9%,4项联合检查定位正确率为100%。定性正确率分别为68.3%,71.4%,87.3%和91.1%,4项联合检查定性正确率为100%。结论:影像学检查对上尿路梗阻病变的定位、定性诊断起重要作用,4种检查方法各有优缺点,临床应注意联合检查方法的应用。     

胃肠超声在急危重症中的应用

随着充盈检查技术的规范化推广应用,超声在胃肠疾病的诊断中发挥越来越大的作用,已成为继内窥镜、X线后又一客观影像学检查方法。胃肠超声尤其对胃肠急危重症如消化道穿孔(或破裂)、梗阻、扭转、异物损伤、血管栓塞等具有较高的诊断准确率,不仅能快速判断病因,确定病变部位和性质,且能联合介入超声,结合临床和相关检查对病情进行全面评估、监测,为临床围手术期诊疗提供精准的指导和帮助。胃肠超声以其便捷、无创、价廉、直观、重复性好、准确性高等优点,已成为临床首选检查方法。笔者旨在总结探讨超声在胃肠急危重症诊断中的应用价值,为临床工作提供参考依据。     

高频超声诊断新生儿十二指肠梗阻性疾病的价值

目的 探讨高频超声在新生儿十二指肠梗阻性疾病诊断中的价值.方法 回顾性分析113例新生儿十二指肠梗阻性疾病的超声检查结果、临床资料及术后病理结果.结果 113例经手术证实为十二指肠梗阻的病例中,高频超声诊断正确106例,诊断率为 93.81%(106/113).其中肠旋转不良、十二指肠膜式狭窄、十二指肠闭锁、环状胰腺的超声诊断率分别为 96.83%(61/63)、93.55%(29/31)、80.00%(4/5)、85.71%(12/14).同时,92例超声提示梗阻部位与术中所见一致,超声对梗阻部位的诊断率为 81.42%(92/113).结论 高频超声在新生儿十二指肠梗阻病因诊断及梗阻部位判断中有重要价值,可作为新生儿十二指肠梗阻性疾病的首选检查方法.

Abstract：

Objective To evaluate the clinical significance of high frequency ultrasound in the diagnosis of duodenal obstruction in neonates.Methods Ultrasonography,clinical data and etiological diagnoses of the operation in 113 neonates with duodenal obstruction were reviewed retrospectively.The digestive tract,including stomach,duodenum,jejunoileum and colon,were examined in all patients with 8-12 MHz linear transducer before operation.Results In the 113 neonates with duodenal obstruction,63 cases were diagnosed intestinal malrotation,31 cases duodenal stenosis,14 cases annular pancreas,and 5 cases duodenal atresia.One hundred and six cases were diagnosed as duodenal obstruction by ultrasound,of which intestinal malrotation in 61 cases,duodenal stenosis in 29 cases,duodenal atresia in 4 cases,and annular pancreas in 12 cases.The diagnostic rate was 93.81% (106/113 cases),96.83% (61/63 cases),93.55% (29/31 cases),80.00% (4/5cases) and 85.71% (12/14 cases),respectively.The location of obstruction diagnosed by ultrasound was coincident with the operation in 92 cases,with a diagnostic rate of 81.42%(92/113).Conclusions High frequency ultrasound plays an important role in diagnosing the causes and location of duodenal obstruction.It can be used as the first choice of examinal methods for the neonates with duodenal obstruction.     

Contribution of fetal magnetic resonance imaging and amniotic fluid digestive enzyme assays to the evaluation of gastrointestinal tract abnormalities.

OBJECTIVE: To analyze the contribution of fetal magnetic resonance imaging (MRI) and amniotic fluid digestive enzyme (AFDE) assays to the evaluation of gastrointestinal tract abnormalities. METHODS: This was a prospective study involving 24 fetuses suspected of having gastrointestinal tract abnormalities on ultrasound examination. MRI was used to analyze the location of the obstruction, the visibility of the small bowel not involved in the obstruction, and the visibility and size of the colon and rectum. Abnormalities were further evaluated by AFDE assays. The final diagnosis was based on postnatal or fetopathological examination. RESULTS: In duodenojejunal obstructions, MRI (6/6) and AFDE assays (4/4) correctly identified the level of obstruction, but were less accurate for small bowel obstructions (MRI, 10/11; AFDE assays, 7/11). The small bowel not involved in the obstruction was correctly evaluated by MRI as being viable in six cases and as abnormal in eight cases (multiple obstructions or necrosis). However, it was thought antenatally to be abnormal by MRI in four cases in which it was found to be normal on postnatal findings. Three cases in which the colon was found to have abnormal echogenicity were considered normal both by MRI and AFDE assay, in agreement with postnatal findings. Two cases of microcolon-megacystis-intestinal hypoperistalsis syndrome (MMIHS) were diagnosed both by MRI and AFDE assay. Of the three anorectal malformations, two were overlooked by ultrasonography and one by MRI. MRI also overlooked 2/3 associated rectourethral fistulas. CONCLUSION: MRI and enzyme analysis are good complementary tools to ultrasonography for identifying the level of gastrointestinal obstruction and diagnosing MMIHS. MRI can assess the normality of the intestinal tract not involved in the obstruction, but not multiple obstructions, necrosis and small urodigestive fistulas.     

The endoscopic variety of duodenal villous adenoma - an experience with ten cases

Ten cases of villous adenoma of the duodenum among 8,754 endoscopic examinations of the upper gastrointestinal tract were found over a nine year period. The varied clinical manifestations included gastrointestinal bleeding in five cases, partial duodenal obstruction in four, and jaundice with common bile duct obstruction in two. In only two cases did radiological examination indicate the diagnosis of villous adenoma of the duodenum in all ten cases preoperatively but was negative for carcinoma in one. Due to improved diagnostic techniques villous adenoma of the duodenum is being diagnosed at an early stage, and with appropriate surgical treatment the survival rate for this group of patients should improve.     

超声内镜对上消化道隆起性病变的诊断和治疗价值

目的评价超声内镜在上消化道隆起性病变诊断和治疗中的价值。方法对236例上消化道隆起性病变患者,先行胃镜及超声内镜检查,将超声内镜对上消化道隆起性病变的总诊断符合率与胃镜检查结果进行比较。结果对上消化道隆起性病变的总诊断符合率,超声内镜为91.2%,明显高于胃镜的60.4%（P〈0.01）。结论超声内镜对上消化道隆起性病变的部位、大小及性质较胃镜能做出更准确判断,并对其治疗方案的选择具有重要的指导意义,超声内镜对间质瘤和平滑肌瘤的鉴别诊断及良、恶性的判断尚存在一定困难。     

彩色多普勒超声对胃肠道穿孔的诊断价值探讨

目的探讨胃肠道穿孔的声像图特点及其诊断价值。方法对116例经手术证实为消化道穿孔患者的彩色多普勒超声检查结果与X线检查结果进行回顾性对比分析。结果 116例患者中,彩色多普勒超声诊断腹腔游离气体为103例,占88.8%;腹盆腔积液107例,占92.2%;腹腔包块和包裹性积液8例,占6.9%;发现穿孔部位51例,占43.9%;X线诊断腹腔游离气体95例,占81.9%;13例包裹性消化道穿孔彩色多普勒超声和X-线均未发现游离气体。结论彩色多普勒超声检查对胃肠道穿孔的早期诊断具有重要价值。     

膈疝的影像学特征及其诊断价值（附31例分析）

目的：分析膈疝的胸部平片、胃肠道钡餐造影及胸部CT影像学特征，探讨其诊断价值。材料与方法：对31例具有完整的临床、影像学、手术病理资料的膈疝病例进行全面的分析。结果：平片检查快速、简便，价格低廉，但诊断价值有限，正确率仅41．9％；钡餐造影明显优于平片，正确率77．4％，但对实质性脏器显示能力差，易致误诊；CT检查可清楚显示疝内容物及膈肌缺损部位及范围，但对滑动性疝易漏诊且不能反映胃肠道功能。结论：三种影像学检查方法分别有其特点，临床上应将三者有机结合，以充分提高膈疝诊断正确率，改善预后。     

MSCT肾动脉造影与尿路造影同步显示对尿路梗阻性疾病诊断价值

目的探讨多层螺旋CT血管造影（MSCTA）与多层螺旋CT尿路造影（MSCTU）同步显示对尿路梗阻性病变的诊断价值。方法对36例经超声或IVU拟诊为尿路梗阻的患者行MSCTA、MSCTU同步显示扫描,并通过后处理重组技术获得图像。结果36例尿路梗阻中肾及输尿管畸形3例,副肾动脉压迫肾盂输尿管连接处4例,泌尿系结石16例,泌尿系炎症5例,外源性压迫3例,泌尿系占位5例。结论MSCTA与MSCTU同步显示技术能同时清晰显示血管与集合系统,可提高尿路梗阻性疾病的诊断能力,并有效减少辐射剂量。