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,以加深对本病的进一步认识。方法收集我院1998~2005年,经X线及临床证实明确诊断病例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腹透多体位方法诊断,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,男性婴儿22例,女性10例。年龄最大8 d,最小12h,平均4 d。32例病例中,伴胃肠穿孔4例,除2例死亡外,其余30例病愈后出院。结论新生儿坏死性小肠结肠炎早期表现不明显,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,及早诊断胃肠穿孔,指导临床及早采取手术治疗措施,对挽救患儿生命具有重要价值。

X-ray Diagnosis on Neonate Necrosis Enterocolitis

Objective To discuss the X - ray manifestation of neonate necrosis enterocolitis so that to enhance the recognition of it. Methods The clinical and X - ray materials of 32 cases that obtained the diagnosis from 1998 to 2005 were discussed. The PA, EP and HL were taken to detect disease 12 N 24 h observation as well as abdominal perspective. Results 30 cases were premature and 2 cases were born before 38 weeks. The early diagnosis in 5 cases were shown as incomplete obstruction of intestine with widen intestinal gap, obscure and unclear of abdominal fat line. The typical diagnosis in 21 cases were shown as accumulation of gas in intra - wall of gastro - intestine and intestinal lumen, disorder of arrangement with fixation of local intestine. The late stage diagnosis in 6 cases were shown as extensive accumulation of gas in intra - wall of gastrointestine and pneumoperitoneum. There were 22 cases real and 10 cases female with average age of 4 d. 2 cases died and 4 cases accompanied with perforation. 30 cases healed. Conclusion The early stage manifestation was not clear. The X - ray detection for the suspicious case should be taken carefully so that early diagnosis could be obtained and indicate the clinical treatment with great value.