超声在儿童结肠息肉诊断中的应用价值

目的探讨超声对儿童结肠息肉的诊断价值及其超声声像图特征。方法回顾性分析342例术前进行超声检查并经结肠镜及病理证实的结肠息肉患儿的超声表现。结果 342例患儿中男244例,女98例。224例(65.5%)患儿发病年龄为3～6岁。单发息肉333例,位于乙状结肠226例,直肠41例,余段结肠66例。多发息肉9例,共33枚。息肉最大5.3cm×1.7cm×3.1cm,最小0.6cm×0.5cm×0.5cm。超声诊断332例(97.1%),超声表现均为中等回声结节,其内部可探及小囊腔且CDFI血供丰富,可探及蒂血流及息肉内部树枝状血流。<1cm的息肉囊腔及蒂结构不明显,但CDFI可探及明确的血流信号。16例患儿超声检出合并继发肠套叠,表现为同心圆征象,套入起始部肠腔内可探及息肉回声。其中14例患儿息肉位于降结肠及结肠脾曲。结论超声诊断儿童结肠息肉方便、无创、无放射性且检出率高,是血便患儿首选检查方法。结肠息肉超声声像图具有特异性,不易与其他病变混淆,在儿童一般不需鉴别诊断。     

超声检查在小儿肠息肉继发性肠套叠诊断中的作用

目的探讨超声检查在小儿肠息肉继发性肠套叠中的诊断价值,并总结其声像图的特点,为临床治疗方式的选择提供依据。方法回顾性分析我院因肠息肉致肠套叠的36例患儿的超声图像、治疗方法及效果。结果 36例患儿均具有肠套叠的典型超声表现,即短轴呈"同心圆"征,长轴呈"假肾"征,超声诊断结果与临床诊断一致。其中10例(27.8%)超声诊断出息肉病变,声像图表现为在套头内或套头边缘发现实质性病变,为中等回声;CDFI可见丰富的放射状血流信号,明确诊断后,临床采用空气灌肠后行电子肠镜息肉切除术,顺利恢复出院。仍有26例患儿超声仅发现肠套叠征象,行空气灌肠后又复发肠套叠,23例(63.9%)患儿行剖腹探查及肠息肉切除术,3例(8.3%)患儿行剖腹探查及肠切除肠吻合术。结论超声可准确判断套叠部位肠壁的血供,并发现息肉帮助临床明确病因,从而指导治疗方式的选择。     

彩色多普勒超声检查在诊断肠息肉引起的小儿继发性肠套叠中的价值研究

目的 探讨超声在诊断肠息肉引起的小儿继发性肠套叠中的价值,并总结其声像图的特点,为临床治疗方式的选择提供依据。 方法 本文回顾性分析我院2010年1月至2017年5月肠息肉致肠套叠患儿36例,均进行使用彩色多普勒超声低频和高频探头进行腹部扫查,分析其临床表现、超声图像、治疗及预后。结果 36例患儿年龄1月至11岁,临床症状主要包括阵发性哭吵、腹痛、血便及呕吐。36例患儿均具有肠套叠的典型超声声像图表现,即短轴呈“同心圆”征,长轴呈“假肾”征,超声诊断结果与临床诊断一致;其中10例(27.8％)超声诊断出息肉病变,声像图表现为在套头内或套头边缘发现实质性病变,为中等回声,CDFI可见丰富的放射状血流信号,明确诊断后,临床采用空气灌肠后行电子肠镜息肉切除术,顺利恢复出院;仍有26例患儿超声仅发现肠套叠征象,行空气灌肠后又复发肠套叠,23例(63.9％)患儿行剖腹探查及肠息肉切除术,3例(8.3％)患儿行剖腹探查及肠切除肠吻合术。结论 彩色多普勒超声检查诊断小儿肠套叠的敏感性和特异性极高,在对于肠息肉引起的小儿继发性肠套叠的诊断中,能发现息肉明确病因,指导治疗方式的选择。     

彩色多普勒超声对成人肠套叠肿瘤性病因筛查

目的 探讨成人肿瘤性肠套叠声像图特征.方法 对12例经手术确诊的成人肠套叠声像图进行分析,总结其声像图特征.结果 12例肠套叠,均具有典型声像图表现即:横断面呈"同心圆征"、纵断面呈"套管征",特异性为100%.9例肿瘤引起的肠套叠,超声术前明确诊断7例(78%).其中,同心圆或套筒征内肿瘤2例,表现为同心圆结构偏心性突然改变、套筒征中相平行的强弱回声线之间分离或抬高;肠套叠顶(远心)端肿瘤5例,表现为肠套叠顶(远心)端实性回声;4例实性肿块内呈现相对丰富的彩色血流信号,3例实性肿块内呈现彩色血流信号缺失表现.结论 彩色多普勒超声在对成人肠套叠肿瘤性病因筛查中有重要的诊断价值.     

超声诊断对空气整复小儿肠套叠可行性的评价

目的如何从声象图上识别在X-线下行空气加压灌肠整复小儿肠套叠的成功与否.方法回顾性分析由超声诊断小儿肠套叠139例,均经空气整复,其中79例空气整复成功,60例经1-3次空气整复不成功而手术.结果空气整复成功患儿声像图为圈外有圈的同心圆,每层厚度为0.15±0.02cm,手术患儿的同心圆声像图的环状暗带厚薄不均伴肠管局限性扩张、积液.结论超声诊断能为临床提供小儿肠套叠能否行空气整复及成功的概率.     

小儿美克尔憩室继发肠套叠的高频超声表现

目的探讨高频超声对小儿美克尔憩室继发肠套叠的诊断价值。方法回顾性分析15例经手术和病理证实为美克尔憩室继发肠套叠患儿的术前超声诊断和声像图特征。结果 15例患儿术前超声检查均发现肠套叠,肠套叠诊断符合率100%。超声发现美克尔憩室11例,病因诊断符合率73.3%。美克尔憩室继发肠套叠的典型高频声像图表现:美克尔憩室位于套叠头端,横断面呈一厚壁囊状结构,纵断面呈一椭圆形或管形结构,一端为盲端,另一端与肠管相连。结论术前超声检查不仅可以明确肠套叠的诊断,而且还能发现大部分美克尔憩室的存在,可作为美克尔憩室继发肠套叠的首选检查方法。     

高频超声对小儿肠息肉的诊断价值

小儿肠息肉是小儿常见病,也是小儿便血的常见原因.以往多依靠结肠镜检查或X线钡剂灌肠检查而确诊,有关超声对小儿肠息肉的诊断鲜有报道.本研究对经手术和病理证实的19例肠息肉患儿术前进行超声检查,观察小儿肠息肉声像图表现和血流特征,探讨高频超声对小儿肠息肉的诊断价值,报告如下. 资料与方法     

神经母细胞瘤超声诊断及图像分析

目的总结神经母细胞瘤临床及超声声像图特征.方法对52例手术病理检查证实为神经母细胞瘤患儿的临床和超声声像图特征进行总结分析.结果52例神经母细胞瘤患儿中≤1岁14例(14/52,26.9%),>1岁38例(38/52,73.1%),其中大于10岁2例,男∶女为1.26∶1.超声声像图表现:(1)52例肿瘤大小1.0~20.0 cm;其中37例(37/52,71.2%)肿瘤边界不清,形态不规则;49例(49/52,94.2%)表现为低回声,3例(3/52,5.8%)表现为稍高回声;35例(35/52,67.3%)肿瘤内伴钙化;17例(17/52,32.7%)肿瘤内液化;28例(28/52,53.8%)肿瘤内部见较丰富血流信号,24例(24/52,46.2%)血供不丰富.(2)52例神经母细胞瘤位置较固定,多位于腹膜后和双侧肾上腺区(37/52,71.2%),不随呼吸或体位改变而移动,多推挤周围脏器(31/52,59.6%)或包绕腹部大血管(19/52,36.5%).结论超声检查发现患儿腹膜后低回声肿瘤应考虑可能为神经母细胞瘤,结合临床、肿瘤部位及超声声像图表现有助于正确诊断神经母细胞瘤,确诊需依据病理诊断.     

超声在小儿肠套叠诊治中的应用79例分析

目的 探讨超声对小儿肠套叠的诊断与治疗的应用价值.方法 回顾分析79例小儿肠套叠患者超声声像图特点及水压灌肠复位情况.结果 小儿肠套叠的超声图像有特征性改变,"套筒征"、"靶环"征为其典型表现.其中有67例经超声监视下水压灌肠完全复位证实,复位成功率为84%.结论 超声显像对小儿肠套叠的诊断和治疗开辟了新的途径,价值较大.     

胆囊息肉样变42例声像图分析

目的 回顾性分析胆囊息肉样病变42例声像图特征,旨在提高超声诊断的准确性.方法 对42例经病理证实的胆囊息肉样病变的声像图与病理进行对比分析.结果 胆固醇息肉21例,占50%;炎性息肉4例,占9.5%;单纯性腺瘤8例,占19%;乳头状腺瘤8例,占19%;胆囊肌腺瘤1例,占2.3%.有4例为2种类型合并发生,伴慢性胆囊炎者9例,伴胆囊结石者4例,单发者28例,多发者14例.超声诊断与病理诊断符合率为93.6%.结论 声像图根据息肉数目、大小、形态、基底宽窄及血流情况,可初步判断其性质,为临床提供了必要的诊断信息.     

Video capsule endoscopy in peutz-jeghers syndrome: a blinded comparison with barium follow-through for detection of small-bowel polyps

BACKGROUND AND STUDY AIMS: Video capsule endoscopy has shown promise for the surveillance of significant small-bowel polyps in patients with Peutz-Jeghers syndrome. In this study the yield of significant small-bowel polyps by capsule endoscopy was compared to the yield of these polyps by barium follow-through in adults with Peutz-Jeghers syndrome. PATIENTS AND METHODS: A total of 19 adults with Peutz-Jeghers syndrome who were undergoing surveillance underwent both capsule endoscopy and barium follow-through examinations, and the number of small-bowel polyps of at least 1 cm in diameter that were detected was recorded for each method. The two methods were assessed in terms of comfort and convenience for the patients and their preferred future surveillance method, using a questionnaire. RESULTS: Capsule endoscopy detected a median of four significant small-bowel polyps while barium follow-through detected a median of one (P = 0.008). There was a trend towards more participants having at least one significant small-bowel polyp detected by capsule endoscopy than was the case with barium follow-through, though capsule endoscopy seemed to be less reliable for accurate sizing of polyps that were at the limit of clinical significance. Most participants expressed a preference for capsule endoscopy for future surveillance. CONCLUSIONS: Capsule endoscopy should replace barium follow-through for the surveillance of small-bowel polyps in adults with Peutz-Jeghers syndrome, but the findings of this study should be interpreted with caution until a more reliable means of sizing polyps by capsule endoscopy is available.     

Peutz-Jeghers综合征9例临床分析

目的:提高Peutz-Jeghers综合征(Peutz-Jeghers syndrome,PJS)的诊治水平。方法:通过分析2003年—2011年复旦大学附属中山医院收治的9例PJS患者的临床资料,结合文献复习,探讨PJS的发病机制、临床表现、诊断、治疗及预后。结果:9例患者发病年龄1～49岁,有家族史者5例(56%)。6例1次或多次行内镜下胃肠道息肉切除术,术后其症状明显好转,其中1例并发肠套叠导致小肠部分缺血坏死而行小肠部分切除术;2例因息肉巨大而无法在内镜下将其切除,患者拒绝外科手术治疗自动出院;1例就诊时结肠息肉已癌变并全身多发转移,患者放弃治疗。结论:PJS患者有肿瘤易感性,内镜下行胃肠道息肉切除术和定期随访可降低息肉引起的并发症的发生率,并降低患者发生恶性肿瘤的风险。     

The bright edge of the endometrial polyp.

OBJECTIVE: To evaluate the accuracy of sonographic detection of endometrial polyps using a new ultrasound marker denoted 'the bright edge of the polyp'. METHODS: The ultrasound scans of the uterus were examined for the presence of the bright edge in two groups of women. The first, a retrospective group, included 40 women in whom both a histological diagnosis of endometrial polyps and sonographic scans were available for evaluation. The second, a prospective group, included 80 women scheduled for operative hysteroscopy because of endometrial irregularities detected by sonography. In this group the hysteroscopical and histological results of the removed endometrial tissue were correlated with the sonographic diagnosis. RESULTS: In the retrospective group, the bright edge marker, indicative of the presence of a polyp, was detected in 30 out of 40 scans available for evaluation. In the prospective group this marker was detected in 60 women out of 80. Endometrial polyps were confirmed in 56 of these 60 women. In three cases a submucosal myoma was found and in one case the histology showed simple cystic hyperplasia. Two polyps were found in 20 cases where the bright edge had not been detected. This marker has a sensitivity of 96%, specificity of 82%, positive predictive value of 93%, and negative predictive value of 90% in this group at high risk for endometrial abnormalities. CONCLUSION: The bright edge of the polyp is an accurate sonographic marker for the detection of endometrial polyps in women with endometrial irregularities demonstrated on ultrasound.     

Peutz-Jeghers综合征八例

目的分析Peutz-Jeghers综合征临床特点,以提高诊治水平。方法 2008年11月2010年1月对8例Peutz-Jeghers综合征的临床资料进行回顾性分析。结果男女各4例,年龄13～41岁,病程20d～40年。8例均有黑斑和息肉,5例有明确的家族史。首发表现以腹痛为主,轻度抑郁表现2例,并发肠套叠2例,结肠癌1例。病理报告：错构瘤4例。外科手术治疗1例,结肠镜治疗6例,保守治疗1例。结论 Peutz-Jeghers综合征易并发抑郁症、肠套叠和恶性肿瘤,患者需心理治疗和遗传咨询,肠镜下息肉切除是主要手段。     

内镜下钳夹活检诊断胃息肉病变性质及与病理诊断的差异

  目的  分析内镜下钳夹活检诊断胃息肉的病变性质,探究其与内镜下胃息肉切除术后标本的病理诊断结果的差异。  方法  回顾性选取2021年2月~2022年2月于本院消化内科行内镜下钳夹活检诊断及内镜下胃息肉切除术的145例患者的临床资料,分析内镜下钳夹活检诊断胃息肉的病变性质,并对比其与内镜下胃息肉切除术病理检查结果的一致性,评价影响内镜下钳夹活检诊断与病理诊断胃息肉差异的影响因素。  结果  145例患者中单发息肉124例（85.52%）,多发息肉21例（14.48%）。共检出171枚息肉,内镜下钳夹活检诊断与电切术后病理学诊断结果一致的共119枚（69.59%）,不一致的共52枚（30.41%）。两种诊断的病理学诊断结果的Kappa值为0.182,差异有统计学意义（P < 0.05）。Logistic多因素分析结果显示,患者年龄≥60岁、息肉大小≥2.0 cm是影响内镜下钳夹活检与电切术后病理学诊断间组织学差异的独立影响因素。  结论  内镜下钳夹活检诊断胃息肉病变性质及与病理诊断胃息肉结果存在不一致性,尤其对于年龄≥60岁、息肉大小≥2.0 cm的患者的差异更大,在临床诊断中应格外注意此类患者的胃息肉与癌变病灶并存现象。      

Diagnosis and management of gastrointestinal polyps: pediatric considerations.

Painless, bright red, rectal bleeding with normal stool frequency and consistency is the hallmark presentation of colorectal polyps at any age. Most polyps in children are sporadic, usually isolated, colorectal juvenile polyps that do not require any further surveillance after they are removed. There is, however, increasing recognition of syndromes, including familial adenomatous polyposis, juvenile polyposis coli, Peutz-Jeghers syndrome, and infrequent conditions, such as PTEN hamartoma and hereditary mixed polyposis syndromes. The aim of this review is to allow the reader to correctly identify the patients who do not require follow-up and the smaller group of patients who do require follow-up because of syndromic polyp conditions.     

Rectal Carcinoma in a Young Female Patient with Peutz-Jeghers Syndrome: A Case Report

Objective

To report a case of rectal cancer in a patient with Peutz-Jeghers syndrome (PJS).

Clinical Presentation and Intervention

A 20-year-old woman with intermittent bloody stool of 4 months was admitted for examination. Gastroendoscopy revealed multiple polyps involving the stomach, small intestine, colon and a rectal adenocarcinoma. A diagnosis of PJS was made based on intestinal polyps with characteristic pathology and melanotic macules on the lips. After surgery and chemotherapy upon follow-up at 8 months, the patient did not have any signs of recurrence.

Conclusion

This case showed that rectal carcinoma should be considered for young patients with PJS.Key Words: Peutz-Jeghers syndrome, Rectal carcinoma, Cancer risk, Hamartomatous polyp, Intussusception     

Wireless capsule endoscopy for evaluation of phenotypic expression of small-bowel polyps in patients with Peutz-Jeghers syndrome and in symptomatic first-degree relatives

BACKGROUND AND STUDY AIMS: Peutz-Jeghers syndrome (PJS) is an inherited gastrointestinal hamartomatous polyposis disorder. Small-bowel intussusception and bleeding are the most common complications, and malignancy may also occur. Survey of the gastrointestinal tract, particularly of the small bowel, is difficult and current recommendations for management syndrome are ambiguous. We evaluated the feasibility of capsule endoscopy for identifying phenotypic expression of small-bowel polyps in patients with full-blown PJS and a previous diagnosis of gastrointestinal polyposis, and in symptomatic kindred of PJS patients with no previous diagnosis of gastrointestinal polyposis. PATIENTS AND METHODS: Two groups were studied: group A consisted of 14 patients with gastrointestinal polyposis, eight of whom had undergone previous small-intestine surgery; group B consisted of six symptomatic first-degree relatives of PJS patients; these patients had previous negative gastrointestinal endoscopic examinations. RESULTS: Numerous polyps were detected in all patients in group A. Most polyps were sessile, but the larger polyps tended to be pedunculated. Polyp density was highest in the jejunum (greater than in the ileum and duodenum). Seven patients had at least one large polyp (> 11 mm) and five of these patients subsequently underwent enteroscopy, which revealed that capsule endoscopy had correctly identified all the patients with large polyps, but had missed 20 % of the total number of large polyps in these patients. No polyps were detected by capsule endoscopy in group B patients, despite the excellent visualization of the small intestine. In all patients, the capsules were expelled within 24 hours, without complications, and the procedure was well tolerated. CONCLUSIONS: Capsule endoscopy is an effective and well-tolerated method for evaluating small-bowel pathology in patients with PJS.     

结肠息肉的X线双对比造影诊断(附65例分析)

目的探讨结肠息肉的X线双重对比造影表现及意义。方法65例结肠息肉患者行双重对比造影检查,并经手术病理证实。结果结肠息肉单发40例,多发25例,共98枚,直径5mm～30mm,恶变2例,共3枚。良性表现为边缘光整、圆形或椭圆形充盈缺损影80枚,双环影18枚;恶性表现为外形呈三角形、边缘模糊,1枚表面有浅凹陷、管壁僵硬。造影检出95枚,检出率97%(95/8)。结论双重对比造影对结肠息肉的诊断阳性率较高,对早期的良恶性可作初步鉴别。     

Colorectal polyps and the risk of subsequent carcinoma

Of 323 patients with colorectal polyps that either were larger than 1 cm in diameter or were 1 cm or smaller but had been subjected to biopsy or excision, 20 (6%) had subsequent development of a colorectal carcinoma, an incidence rate of 4.6 per 1,000 person-years of follow-up. These 20 cases of cancer compared with 7.38 cases expected; thus, the risk of colorectal carcinoma in these patients was 2.7 times that in the general population (P less than 0.001). Although risks were greater for certain subgroups of patients, the differences detected were usually modest. We conclude that patients with large colorectal polyps (more than 1 cm in diameter) should be closely followed up after treatment of the initial polyp, regardless of the size, site, or histologic type of the polyp, the age or sex of the patient, or the type of initial treatment (excision or fulguration). Those patients with more than one polyp, especially if more than one segment of the colon is involved, need special attention. Examination of the entire colon is important because the site of development of carcinoma may be distant from the site of the initial polyp.