新生儿坏死性小肠结肠炎X线诊断

目的探讨新生儿坏死性小肠结肠炎X线表现,加深对本病的进一步认识。方法收集我院1998~2005年经X线及临床确诊病例32例。均采用腹部仰卧前后位、立位摄片,必要时摄水平侧位片及多体位腹透方法诊断,对早期病变采用间隔12~24 h追踪观察,观察其病变发展过程,指导临床及早采取相应的治疗措施。结果32例中,30例为早产儿,2例为未足周产儿,诊断早期表现仅5例,主要X线表现为不完全性小肠梗阻,肠间隙增宽、模糊,腹脂线不清,占16%。典型期表现21例,主要X线表现为胃/肠壁内局限性壁内积气,肠管积气扩张,排列紊乱,部分肠管固定,占66%。晚期表现6例,主要X线表现为胃肠壁内广泛散在积气及气腹影,占18%。32例病例中,伴门静脉积气2例,伴胃肠穿孔4例,除2例死亡外,其余30例经临床治疗病愈后出院。结论新生儿坏死性小肠结肠炎早期X线表现不明显,容易误诊、漏诊,若临床怀疑有NEC表现,X线检查一定要全面细致,如侧卧水平位投照可观察到少量气腹影,及早诊断胃肠穿孔,指导临床及早采取手术治疗,对挽救患儿生命具有重要价值。

X-ray Diagnosis on Necrotic Enterocolitis of Neonate

Objective To discuss the X-ray appearance of necrotic enterocolitis(NEC) of neonate and improve the further recognition.Methods 32 cases of such patient who obtained the diagnosis with X-ray and clinic from 1998 to 2005 were analyzed.The A-P X-ray in supination and erect position was taken and lateral projection or inspectscope with X-ray were taken if necessary.The early lesion was taken monitor every 12 or 24 hours to observe the changes and indicate the relative treatment.Results There were 5 cases of 32 in early stage,21 cases in typical and 6 cases in late stage when diagnosed.The early appearance was un-complete obstructive of small intestine,widen and obscure of its interspace,unclear of abdominal fat line.The typical appearance was local pneumatosis of intra-gastrointestinal wall and track dilated with disorder as some of them fixed.The late appearance was the extensive pneumatosis of intra-gastrointestinal wall and image of aeroperitoneum.There were male 22 and female 10 cases with average age of 4 days(12 h-8 day).There were 2 cases of pneumatosis of portal vein,4 cases of perforation of digestive tract and 2 died.The other were cured.Conclusion The appearance of early stage might be unclear that easily lead to misdiagnosed.The detail and monitor of X-ray detection should be taken when the case is doubted NEC so that to indicate the further treatment procedure such as operation when needed to improve survival rate.