超声诊断小儿先天性巨结肠的价值

梁晓璐　樊小刚

[摘要] 目的 评价超声诊断小儿先天性巨结肠的价值。方法 选取2005年1月～2016年12月在我院儿外科采用手术诊断确诊先天性巨结肠24例，巨结肠同源疾病22例，均采用超声检测。结果 先天性巨结肠24例、巨结肠同源疾病22例，超声诊断先天性巨结肠敏感性83.33%（20/24），特异性18.18%（4/22），符合率52.17%（24/46），漏诊4例，均为直径在0.5～1.0 cm者。按照所在部位以及病变范围大小，巨结肠表现为近端扩张肠管伴不同程度的气、粪、粪石混杂强回声，后壁衰减，在交界处，可出现远端管径瘪陷、管径细小情况，范围随着病变范围扩大而扩大，甚至出现直线状气体回声，同时随着管径缩小，肠段走形越来越僵硬，蠕动减弱或消失。结论 超声诊断小儿先天性巨结肠的价值较高，无创、便捷，敏感性好，但容易将同源性疾病误诊。

[关键词] 小儿；先天性巨结肠；超声诊断

[中图分类号] R445.1；R726.5 [文献标识码] B [文章编号] 1673-9701（2017）19-0102-03

[Abstract] Objective To evaluate the value of ultrasonography in the diagnosis of congenital megacolon in children. Methods From January 2005 to December 2016， 24 cases of congenital megacolon and 22 cases of allied Hirschsprung's disease who were diagnosed by the surgical method in the Department of Pediatric Surgery in our hospital were given ultrasonography. Results There were 24 cases of congenital megacolon， and 22 cases of allied Hirschsprung's disease. According to the ultrasound， the sensitivity of congenital megacolon was 83.33% （20/24）， specificity was 18.18%（4/22）， and the coincidence rate was 52.17%（24/46）. There were 4 cases of missed diagnosis， whose size of clone was between 0.5-1.0 cm in diameter. According to the location and the size of the lesions， the megacolon showed different degrees of strong mixed echo of proximal expanded intestinal canal combined with gas， feces and stones. The echo of the rear wall was attenuated. At the junction， the size of distal tube was narrowed with small diameter. The echo of the lesion expanded along with the expansion of the lesions， and even a linear gas echo was detected. At the same time， as the diameter became narrowing， the walking shape of intestinal canal was more and more rigid， and peristalsis was weakened or disappeared. Conclusion Ultrasonography in the diagnosis of congenital megacolon in children is of high value， which is noninvasive， convenient and sensitive， but it is easy to be misdiagnosed with homologous diseases.

[Key words] Children； Congenital megacolon； Ultrasonography diagnosis

先天性巨结肠症又称先天性肠神经节缺乏症，是一种常见的先天性消化道畸形，在胎儿期致死率较低，故出生率较高，发病率约为2～5/万人，是第二大先天性畸形[1]。先天性巨肠症危害较大，发生与遗传有关，患儿可出現胎粪排出时间延长、肠梗阻、便秘等并发症，生活质量下降，影响患儿进食，与营养不良关系密切[2，3]。手术是治疗先天性巨结肠的首选方法，一期根治术治愈率较高[4]。小儿先天性巨结肠诊断主要依赖于超声、X线、CT等方案，其中X线、CT接受率较低，超声是首选[5，6]。但有报道显示超声的敏感性较差，容易误诊，特别是近年来内镜技术的普及，有取代超声的趋势。……