本文選題：高分辨率超聲　切入點(diǎn)：梅克爾憩室　出處：《中國醫(yī)學(xué)計(jì)算機(jī)成像雜志》2017年03期 　論文類型：期刊論文

【摘要】：目的:探討高分辨率超聲對梅克爾憩室(MD)的診斷價(jià)值,分析超聲漏診誤診原因,旨在提高超聲對MD的診斷正確率。方法:回顧性分析66例經(jīng)手術(shù)證實(shí)為MD患兒的臨床資料,將術(shù)前超聲檢查的聲像圖表現(xiàn)與手術(shù)、放射性核素檢查、消化道造影或CT結(jié)果對比分析,對超聲漏診誤診及診斷不明確的聲像圖進(jìn)行深入研究,并總結(jié)該病的超聲診斷要點(diǎn)。結(jié)果:超聲正確診斷45例,漏診誤診21例。所有正確診斷的病例表現(xiàn)為右下腹管狀腸管影、囊性回聲包塊或混合回聲包塊,其中25例清楚顯示憩室盲端及與腸腔開口。本組共漏診17例,漏診率25.8%,誤診4例,誤診率6.1%。3例因合并急性闌尾炎穿孔膿腫形成而漏診,3例因繼發(fā)引起腸套疊漏診,4例由于憩室頂端索帶壓迫造成腸梗阻而漏診,2例因臍疝巨大而漏診,1例為腸旋轉(zhuǎn)不良、先天性幽門狹窄而漏診,1例術(shù)前診斷腸重復(fù)畸形而未能仔細(xì)掃查而漏診,另1例漏診為新生兒期合并腸狹窄并穿孔而漏診,2例腹腔氣體回聲致密而漏診;2例誤診為腸重復(fù)畸形,2例誤診為急性闌尾炎。結(jié)論:梅克爾憩室臨床易漏診誤診,小兒以急腹癥及反復(fù)便血就診時(shí),應(yīng)警惕MD的可能。若同時(shí)合并其他急腹癥及消化道畸形時(shí)也不能完全排除MD,并將所有懷疑為MD的患者應(yīng)同時(shí)進(jìn)行放射性核素或消化道造影及CT檢查,以便早期做出正確診斷,盡早手術(shù),改善患者的預(yù)后。
[Abstract]:Objective: to investigate the diagnostic value of high resolution ultrasound in MDS of Meckel's diverticulum, and to analyze the causes of misdiagnosis in order to improve the diagnostic accuracy of MD. Methods: the clinical data of 66 cases of MD proved by operation were analyzed retrospectively. The ultrasonographic findings of preoperative ultrasound examination were compared with those of surgery, radionuclide examination, digestive tract angiography or CT. The main points of ultrasonic diagnosis were summarized. Results: 45 cases were correctly diagnosed by ultrasound and 21 cases were misdiagnosed by missed diagnosis. All the cases with correct diagnosis showed right lower abdominal tube-like intestinal shadow, cystic echo mass or mixed echo mass. In 25 cases, the blind end of diverticulum and the opening of intestinal cavity were clearly shown. 17 cases were missed diagnosis, the missed diagnosis rate was 25.8%, 4 cases were misdiagnosed. The misdiagnosis rate was 6.1%. 3 cases missed diagnosis because of acute appendicitis perforated abscess. 3 cases missed diagnosis of intussusception due to secondary intussusception. 4 cases missed diagnosis and 2 cases missed diagnosis because of huge umbilical hernia. 1 case was intestinal malrotation. Congenital pyloric stenosis and missed diagnosis were found in 1 case of intestinal duplication before operation without careful scanning and missed diagnosis. The other one was misdiagnosed as neonatal complicated with intestinal stricture and perforation, 2 cases with dense gas echo in abdominal cavity, 2 cases with missed diagnosis as intestinal duplication malformation, 2 cases misdiagnosed as acute appendicitis. Conclusion: Meckel's diverticulum is easily misdiagnosed clinically. Children with acute abdomen and repeated hematochezia, We should be alert to the possibility of MD. If other acute abdomen and alimentary tract malformation are combined, MDD can not be completely excluded, and all patients suspected of MD should be examined simultaneously with radionuclide or gastrointestinal angiography and CT so as to make a correct diagnosis at an early stage. Early operation to improve the prognosis of patients.
【作者單位】： 南京醫(yī)科大學(xué)附屬兒童醫(yī)院超聲診斷科;南京醫(yī)科大學(xué)附屬兒童醫(yī)院普外科;南京醫(yī)科大學(xué)附屬兒童醫(yī)院放射科;
【基金】：南京醫(yī)科大學(xué)科技面上項(xiàng)目No.2014NJMU161~~
【分類號】：R445.1;R725.7

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