回盲部超声解剖在诊断小儿肠套叠中的应用价值

目的探讨利用回盲部回盲瓣特有的超声声学特征,明确肠套叠套头所在位置,准确诊断各型肠套叠,为临床进一步处理提供可靠依据。方法回顾性分析经空气灌肠或是手术证实的肠套叠患儿216例,先用低频凸阵探头全腹扫查,发现可疑包块换高频探头仔细观察包块结构,并沿升结肠寻找回盲部、回盲瓣,明确包块所在的肠管位置,观察肠管套入的深度、肠壁水肿程度,系膜血运情况,是否伴有腹腔积液。结果本组216例肠套叠中套头位于结肠肝区176例,横结肠12例,降结肠2例,乙状结肠1例,小肠套叠25例,并发肠梗阻6例,腹腔积液8例。所有小肠套叠病例中,回盲部均显示形态良好,回盲瓣清晰可见。23例小肠套叠在动态观察过程中自行整复,其中2例继发肠梗阻行手术治疗,均为回回型肠套叠。2例回结型肠套叠病史超过72 h,解血便,直接行手术治疗。肠套叠包块横切面呈偏心的＂同心圆＂征,这点有别于其他肠道疾病的＂同心圆＂征;纵切面呈＂套筒征＂,可见多层肠壁结构呈平行管样排列。结论熟练掌握回盲部回盲瓣的解剖声学特征,可明确肠套叠的类型,为临床进一步处理提供可靠依据。

Value of ileocecal ultrasonography anatomy in diagnosing pediatric intussusception

Objective To explore the value of ileocecal junction and ileocecal valve ultrasonography anatomy and set clear intussusception location and accurate diagnosis of various intussusception. Methods A total of 216 pediatric patients with intussusception diagnosed by surgery and air enema was retrospectively analyzed. With low frequency first convex array probe,the abdominal scan,suspicious mass was detected in high frequency probe.Along the ascending colon,the ileocecal junction and ileocecal valve were checked for getting the intussusception location,observing the depth of intussusceptum,the degree of bowel wall edema,mesentery vascular distribution and abdominal cavity effusion. Results Among 216 patients,176 cases of intussusception hedge were located in colon liver area and 12 cases of transverse colon,2 cases of descending colon,1 case of sigmoid colon,25 cases of enteric intussusception,6 cases complicated with intestinal obstruction and 8 cases of peritoneal effusion were determined. In small bowel intussusception cases,ileocecal junction have shown with good structure and ileocecal valve can be clearly seen. Twenty- three cases of small bowel intussusception were recovered in a dynamic observation,in which two cases of secondary intestinal obstruction were treated with operation and 2 cases of ileocolic intussusceptions more than 72 h with bloody stool directly received surgical treatment. Intussusception mass in transverse section appeared to be ＂ concentric circles＂,which was different from other intestinal disease appeared to be concentric circles with the sleeve of Longitudinal section. Conclusion Ileocecal junctiong and ileocecal valve ultrasonography anatomy plays an important role in determinating the type of intussusception and provides a reliable basis for further clinical treatment.