本文選題：彩超　切入點(diǎn)：腸旋轉(zhuǎn)不良　出處：《泰山醫(yī)學(xué)院》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 分析小兒先天性腸旋轉(zhuǎn)不良的聲像圖特征，結(jié)合手術(shù)及病理結(jié)果，總結(jié)該病的特征性表現(xiàn)，評價超聲在診斷小兒先天性腸旋轉(zhuǎn)不良的應(yīng)用價值，為進(jìn)一步提高超聲在診斷小兒先天性腸旋轉(zhuǎn)不良的準(zhǔn)確性進(jìn)行分析研究。 資料與方法 1臨床資料 對自2011年12月~2012年12月在山東大學(xué)齊魯兒童醫(yī)院因嘔吐就診并被醫(yī)師懷疑為消化道畸形的62例患兒進(jìn)行了超聲影像與手術(shù)病理對照分析。男39例，女23例，男女比例1.7：1。入院時間:出生數(shù)小時～7天32例,7～28天15例，28天~1歲9例，大于1歲6例。62例患兒因不同程度的嘔吐就診。伴有便血7例，伴有黃疸23例，營養(yǎng)不良20例。24例患兒臨床檢查發(fā)現(xiàn)胃腸型，38例僅見腹部略脹；20例伴有不同程度的水電解質(zhì)紊亂。11例患兒在胎兒時期診斷為羊水過多，，可疑消化道畸形。 2儀器設(shè)備與檢查方法 philips iu22、HDI5000彩超儀，采用線陣探頭L12-5，頻率8-12HZ。檢查前根據(jù)患兒情況，適當(dāng)喂奶或喝水充盈胃腔�；純合热�(cè)臥位觀察幽門發(fā)育及開閉情況以及十二指球部腸充盈情況。然后患兒取仰臥位，全腹探測，注意觀察十二指腸、小腸、大腸等是否存在梗阻、擴(kuò)張及狹窄等。并注意腸管的蠕動及充氣情況，這也是消化道先天畸形的超聲診斷與鑒別診斷的重要環(huán)節(jié)。然后著重于上腹部橫切面在胰腺頭部尋找SMA和SMV根部,由上至下緩慢移動探頭，注重觀察腸系膜上動脈與腸系膜上靜脈的位置關(guān)系，直至兩者消失，尤其注意使用彩色多普勒動態(tài)觀察腸系膜上靜脈的走形及血管擴(kuò)張情況。橫斷面及縱斷面掃查相結(jié)合由上到下全腹探測。 結(jié)果 62例患兒中，經(jīng)手術(shù)及病理證實的57例患者，術(shù)前均行超聲檢查，其中腸旋轉(zhuǎn)不良41例，超聲診斷44例；36例伴發(fā)腸扭轉(zhuǎn)，8例為單純性。十二指腸膜狀狹窄及閉鎖10例，超聲診斷10例；環(huán)狀胰腺3例，超聲診斷3例；腸重復(fù)畸形2例，超聲診斷2例。急性腸套疊1例，超聲診斷1例，無明顯外科疾患者2例。12例患兒合并兩種及以上畸形，5例腸旋轉(zhuǎn)不良患兒合并十二指腸膜狀狹窄；3例合并小腸閉鎖；2例合并先天性巨結(jié)腸；8例合并不同類型的先天性心臟��；3例患者為21-3體綜合征。 1腸旋轉(zhuǎn)不良 ①36例伴發(fā)扭轉(zhuǎn)的腸旋轉(zhuǎn)不良患兒，超聲檢查可見SMV圍繞SMA旋轉(zhuǎn)，呈“漩渦征”。于腹主動脈前方腸系膜根部可見直徑約2cm的低回聲包塊，呈螺旋狀，邊界清，邊緣規(guī)整，隨探頭由上向下可見該包塊呈順時針旋轉(zhuǎn)約180°~720°不等,腸系膜血管可見不同程度的擴(kuò)張，寬度約在0.2~0.8cm。彩色多普勒顯示包塊內(nèi)呈紅藍(lán)相間的漩渦狀血流環(huán)繞，外層為靜脈，內(nèi)層為動脈血流信號。手術(shù)證實為腸旋轉(zhuǎn)不良并腸扭轉(zhuǎn)。 ②超聲診斷的8例單純性腸旋轉(zhuǎn)不良患者。其中4例SMV位于SMA的左側(cè)者，結(jié)合消化道檢查結(jié)果證實為腸旋轉(zhuǎn)不良。4例SMV位于SMA的前方者，經(jīng)消化道造影證實1例為單純的腸旋轉(zhuǎn)不良，其他3例腸管位置正常，并無旋轉(zhuǎn)不良征象�？紤]為血管位置的正常變異。 2其他消化道疾病 ①超聲診斷的10例十二指腸膜狀狹窄或閉鎖患兒均經(jīng)手術(shù)證實。表現(xiàn)為為胃腔和十二指腸明顯擴(kuò)張，擴(kuò)張的十二指腸遠(yuǎn)端呈一盲端或僅通過一裂隙樣小孔與遠(yuǎn)端腸管相通遠(yuǎn)端腸管萎癟，遠(yuǎn)端腸管充氣明顯減少，患者腸系膜血管位置未見異常。 ②超聲診斷的3例環(huán)狀胰腺患者均經(jīng)手術(shù)及病理證實。表現(xiàn)為胃腔和十二指腸明顯擴(kuò)張，擴(kuò)張的十二指腸遠(yuǎn)端可見胰腺組織環(huán)繞。遠(yuǎn)端腸管萎癟，充氣明顯減少�；颊吣c系膜血管位置未見異常。 ③超聲診斷的1例腸套疊患者。表現(xiàn)為于患者的右上腹腹探及直徑約3.5cm的“靶環(huán)樣”征象，內(nèi)可見淋巴結(jié)回聲，長軸為“套筒征”，診斷為腸套疊，行空氣灌腸術(shù)后復(fù)查，該征象消失�；純喊Y狀消失。 ④超聲診斷的2例腸腔內(nèi)型囊性腸重復(fù)畸形患兒。于患兒右下腹回腸遠(yuǎn)端見一囊樣結(jié)構(gòu)，壁厚有分層，似腸管壁結(jié)構(gòu)，患者近段腸管梗阻擴(kuò)張，超聲診斷為腔內(nèi)型囊性腸重復(fù)畸形，經(jīng)手術(shù)證實。 結(jié)論 通過觀察腸系膜上動脈與腸系膜上靜脈的位置關(guān)系的變化是診斷腸旋轉(zhuǎn)不良的重要方法。當(dāng)腸旋轉(zhuǎn)不良伴發(fā)中腸扭轉(zhuǎn)后超聲可通過“漩渦征”這一特征性表現(xiàn)進(jìn)行診斷，且診斷符合率較高。當(dāng)腸旋轉(zhuǎn)不良不伴發(fā)扭轉(zhuǎn)時，若不仔細(xì)觀察超聲容易漏診，這時應(yīng)重點(diǎn)觀察腸系膜上靜脈與腸系膜上動脈的關(guān)系，當(dāng)腸系膜上靜脈位于腸系膜上動脈的左側(cè)時，可確診為腸旋轉(zhuǎn)不良。當(dāng)腸系膜上靜脈位于腸系膜上動脈的前方時，應(yīng)慎重探測排除或確診本�。ㄔ撉闆r僅有25%為本�。�，必要時應(yīng)結(jié)合消化道造影檢查綜合做出判斷。腸旋轉(zhuǎn)不良是最常見的十二指腸梗阻性疾病，由于該病癥狀與其他小腸梗阻性疾病臨床表現(xiàn)差別不大，因此在檢查中應(yīng)注意鑒別診斷，提高診斷的準(zhǔn)確率。此外，注意觀察是否伴有其他消化道畸形的存在，以便手術(shù)及時處理。超聲檢查準(zhǔn)確快捷，簡單方便，無輻射，在診斷腸旋轉(zhuǎn)不良中有重要的應(yīng)用價值。
[Abstract]:objective
Analysis of sonographic characteristics of children with congenital intestinal malrotation, combined with surgical and pathological results, summarize the features of the disease, evaluate the clinical value of ultrasound in the diagnosis of congenital intestinal malrotation, to further improve the analysis of ultrasound in the diagnosis of congenital intestinal malrotation in children's accuracy.
Information and methods
1 clinical data
From December 2011 December ~2012 in Qilu children's Hospital of Shandong University hospital and physician because of vomiting was suspected in 62 cases of digestive tract malformation were compared and analyzed the ultrasonography and pathology. 39 cases were male, 23 were female, male to female ratio of 1.7:1. admission time: born a few hours to 7 days in 32 cases, 15 cases of 7~28 days. 28 days ~1 years in 9 cases, more than 1 years old in 6 cases of.62 patients with different degree of vomiting. 7 cases were accompanied by blood in the stool, jaundice in 23 cases, 20 cases of malnutrition in.24 patients clinical examination found 38 cases of gastrointestinal type, abdomen slightly swelling; 20 cases of hydropower with different degree electrolyte disorders in.11 patients the children in the fetal period for the diagnosis of polyhydramnios, suspicious digestive tract malformation.
2 instruments and inspection methods
Philips iu22, HDI5000 color Doppler ultrasound, the probe frequency L12-5, 8-12HZ. check before according to the situation of children proper feeding or water filling the stomach cavity. Children take the lateral position and development of open and close observation of Helicobacter pylori and twelve duodenal intestinal filling. Then the infants in supine position, observe the whole abdominal exploration, duodenum, small intestine. E. the existence of such obstruction, dilatation and stricture. And pay attention to the intestinal peristalsis and inflation, which is an important part of digestive tract congenital malformation of the ultrasound diagnosis and differential diagnosis. Then focuses on the abdominal transverse section in pancreatic head for SMA and SMV from roots, slow moving probe, focusing on observing the relative position of mesenteric artery and the superior mesenteric vein, until the two disappeared, especially pay attention to the use of color Doppler dynamic observation of superior mesenteric vein shape and vascular dilatation. Cross and longitudinal Cross section scan is a combination of upper and lower whole abdomen detection.
Result
In 62 cases, 57 patients were confirmed by surgery and pathology of the patients underwent preoperative ultrasonography, including intestinal malrotation in 41 cases, ultrasound diagnosis of 44 cases; 36 cases with volvulus, 8 cases. 10 cases of duodenal membranous stenosis and atresia, ultrasound diagnosis of 10 cases; 3 cases of annular pancreas ultrasound diagnosis, 3 cases; 2 cases were intestinal duplication, ultrasound diagnosis of 2 cases. 1 cases of acute intussusception, ultrasound diagnosis of 1 cases of patients with no obvious surgical disease, 2 cases of.12 patients with two or more kinds of malformation, 5 cases of intestinal malrotation in children complicated with duodenal membranous stenosis; 3 cases with intestinal atresia in 2 cases; associated with congenital megacolon; 8 cases with different types of congenital heart disease; 3 cases of 21-3 body syndrome.
1 intestinal malrotation
A total of 36 cases with intestinal malrotation in hair torsion, ultrasonography shows SMV around the SMA rotation, a "whirlpool". In front of the abdominal aorta mesenteric root diameter of 2cm visible hypoechoic mass, spiral, clear boundary, edge neat, with the probe from up to down the visible mass clockwise rotated about 180 DEG ~720 DEG range, mesenteric vessels showed different degrees of expansion, the width is displayed in the 0.2~0.8cm. color Doppler mass in a swirling flow around the red and blue, the outer layer of the inner vein, artery blood flow signal. Surgery confirmed intestinal malrotation and volvulus.
The ultrasonic diagnosis of 8 cases of intestinal malrotation. Patients including 4 cases of SMV located in the left side of the SMA, combined with the road test results was confirmed by digestion of intestinal malrotation in.4 cases of SMV located in the front of SMA, the digestive tract confirmed 1 cases of simple intestinal malrotation, other 3 cases were normal, no malrotation signs. Considered as a normal vascular variation position.
2 other digestive tract diseases
The ultrasonic diagnosis of 10 cases of duodenal membranous stenosis or atresia were confirmed by surgery. As for stomach and duodenum were dilated, dilatation of the distal duodenum is a blind end or only through a slit like orifice and distal bowel communicated the distal bowel shrinking, distal bowel filling gas significantly reduced, mesenteric vascular patients had no position abnormal.
(2) 3 cases of annular pancreas diagnosed by ultrasonography were confirmed by operation and pathology. The gastric cavity and duodenum were obviously dilated, and the distal duodenal tissue was surrounded by pancreatic tissue. The distal intestine became shrunken and the inflation was significantly reduced. The location of mesenteric vessels was not abnormal.
3. 1 cases of intussusception diagnosed by ultrasound. It is characterized by "target ring like" sign with a diameter of about 3.5cm in the right upper abdomen and abdomen. The echo of lymph nodes is seen. The long axis is "sleeve sign". It is diagnosed as intussusception. After air enema, the sign is disappeared. The symptoms disappear.
(4) ultrasonic diagnosis of 2 cases of enteric cystic duplication of the intestine. A cystic like structure was seen in the distal part of the right lower abdomen. The wall thickness was stratified, resembling the wall structure of the bowel wall. The proximal segment of intestinal obstruction was dilated, and the ultrasonic diagnosis was intracavity type cystic intestinal duplication. It was confirmed by operation.
conclusion
By changing the position between the artery and the superior mesenteric vein to observe mesenteric is an important method in diagnosis of intestinal malrotation. When intestinal malrotation with midgut volvulus after ultrasonic diagnosis can be carried out by the "whirlpool" features, and the diagnosis coincidence rate is higher. When intestinal rotation without adverse reverse, if you do not observe ultrasound easily missed, then the relationship of the mesenteric vein and superior mesenteric artery were observed on the key, when the superior mesenteric vein in superior mesenteric artery to the left, can be diagnosed with intestinal malrotation. When the superior mesenteric vein in superior mesenteric artery in front, should be careful to exclude or diagnose the disease (detection this is only 25% of the disease), when necessary, should be combined with gastrointestinal radiography comprehensive judgment. Intestinal malrotation is the most common disease of duodenal obstruction, because the disease symptoms and other intestinal stem Little difference in clinical manifestations of disease resistance, therefore in the examination should pay attention to the differential diagnosis and improve the accuracy of diagnosis. In addition, observe whether there is associated with other digestive tract malformation, so that the operation in a timely manner. Ultrasonography is quick and accurate, simple and convenient, no radiation, has important application value in the diagnosis of intestinal malrotation.

【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R725.7;R816.92

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 林妙承,潘沁銘,劉潔嫦;先天性腸旋轉(zhuǎn)不良解剖學(xué)變異與術(shù)中處理的關(guān)系[J];腹部外科;2004年05期

2 高錦鷹;;彩色多普勒超聲對先天性腸旋轉(zhuǎn)不良的診斷價值[J];遼寧醫(yī)學(xué)院學(xué)報;2011年04期

3 陳蘭萍,任紅霞,陳淑蕓,韓湘珍;腹腔鏡診治小嬰兒腸旋轉(zhuǎn)不良的探討[J];臨床小兒外科雜志;2004年06期

4 孫鳳霞;劉平;王飛;;旋轉(zhuǎn)不良伴中腸扭轉(zhuǎn)的X線、CT表現(xiàn)[J];河南科技大學(xué)學(xué)報(醫(yī)學(xué)版);2008年03期

5 李敏,王瑋;結(jié)腸造影對新生兒腸旋轉(zhuǎn)不良診斷價值的探討[J];新生兒科雜志;2005年05期

6 李德淵;陳娟;陳大鵬;;新生兒先天性消化道畸形64例臨床分析[J];中國新生兒科雜志;2006年01期

7 王琪;郭萬亮;周珉;;兒童腸旋轉(zhuǎn)不良伴中腸扭轉(zhuǎn)的影像學(xué)分析[J];江蘇醫(yī)藥;2008年07期

本文編號：1569619