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婴幼儿梅克尔憩室的超声诊断要点及漏诊误诊分析

发布时间:2018-03-02 18:33

  本文选题:高分辨率超声 切入点:梅克尔憩室 出处:《中国医学计算机成像杂志》2017年03期  论文类型:期刊论文


【摘要】:目的:探讨高分辨率超声对梅克尔憩室(MD)的诊断价值,分析超声漏诊误诊原因,旨在提高超声对MD的诊断正确率。方法:回顾性分析66例经手术证实为MD患儿的临床资料,将术前超声检查的声像图表现与手术、放射性核素检查、消化道造影或CT结果对比分析,对超声漏诊误诊及诊断不明确的声像图进行深入研究,并总结该病的超声诊断要点。结果:超声正确诊断45例,漏诊误诊21例。所有正确诊断的病例表现为右下腹管状肠管影、囊性回声包块或混合回声包块,其中25例清楚显示憩室盲端及与肠腔开口。本组共漏诊17例,漏诊率25.8%,误诊4例,误诊率6.1%。3例因合并急性阑尾炎穿孔脓肿形成而漏诊,3例因继发引起肠套叠漏诊,4例由于憩室顶端索带压迫造成肠梗阻而漏诊,2例因脐疝巨大而漏诊,1例为肠旋转不良、先天性幽门狭窄而漏诊,1例术前诊断肠重复畸形而未能仔细扫查而漏诊,另1例漏诊为新生儿期合并肠狭窄并穿孔而漏诊,2例腹腔气体回声致密而漏诊;2例误诊为肠重复畸形,2例误诊为急性阑尾炎。结论:梅克尔憩室临床易漏诊误诊,小儿以急腹症及反复便血就诊时,应警惕MD的可能。若同时合并其他急腹症及消化道畸形时也不能完全排除MD,并将所有怀疑为MD的患者应同时进行放射性核素或消化道造影及CT检查,以便早期做出正确诊断,尽早手术,改善患者的预后。
[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.
【作者单位】: 南京医科大学附属儿童医院超声诊断科;南京医科大学附属儿童医院普外科;南京医科大学附属儿童医院放射科;
【基金】:南京医科大学科技面上项目No.2014NJMU161~~
【分类号】:R445.1;R725.7

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