小儿继发性肠套叠超声表现
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摘要
目的观察小儿继发性肠套叠的超声声像图特点。方法回顾性分析我院经病理证实的125例继发性肠套叠患儿的术前超声表现。结果 125例超声表现均为横切面呈"同心圆征",纵切面呈"套筒征",套环内可见异常肿块回声。28例幼年性息肉及2例幼年性息肉病见中低回声肿块伴小片状或类圆形无回声区;19例Peutz-Jeghers综合征见"车轮样"、"放射状"分布或高低回声相间的肿块回声;18例肠重复畸形见囊性肿块,壁厚呈"双环"或"三环"征;17例梅克尔憩室见结节样改变或异常形态的肠襻样回声;11例过敏性紫癜见肠壁明显增厚、血供丰富;6例阑尾炎见管状低回声;5例肠道淋巴瘤见肿块样极低回声,血供丰富;2例回肠腺肌瘤见椭圆形混合回声肿块,低回声区内呈多囊腔样征象;2例脂肪血管瘤见肿块回声;1例十二指肠Brunner腺错构瘤见高回声肿块伴片状低回声区及无回声区;1例肠系膜海绵状淋巴管瘤肠系膜根部见不规则中等回声肿块,边缘可见蜂窝状小囊腔;1例多发性息肉型海绵状血管瘤见不均质低回声肿块;1例肠壁及系膜血管发育畸形见囊性肿块;1例低度恶性血管源性肿瘤见类圆形不均质低回声肿块;10例出血性坏死性小肠结肠炎肠管壁增厚,血供减少或缺失。结论超声可明确小儿继发性肠套叠原发病灶,为临床诊断和治疗提供重要依据。
Objective To observe ultrasonic manifestations of secondary intussusception(SI)in children.MethodsPreoperative ultrasonic features of 125 children with histopathologically proved SI were retrospectively analyzed.ResultsConcentric circle sign in transverse section,sleeve sign in longitudinal section and abnormal mass echoes in intussusception loop were found in all 125 children.Low echo mass with small or round-shaped anechoic area was found in 28 children with juvenile polyps and 2 with juvenile polyposis syndrome.Wheel-like mass,radial distribution or high and low echo interphase were detected in 19Peutz-Jeghers syndrome children,while cystic mass with thick wall showing "double ring" or "three ring" signs was found in 18 intestinal duplication children.Nodular changes or abnormal patterns of intestinal echo were observed in 17 children with Meckel's diverticulum.Obviously thick wall with rich blood supply was found in 11 children with allergic purpuras.Tubular hypoecho was detected in 6appendicitis children.An extremely hypoechoic mass with abundant blood was noticed in 5intestinal lymphoma children,while a mass of mixed echogenicity containing several small cystic areas was found in 2ileal adenomyoma children.A mass echo was found in 2lipoangioma children.A medium and high echo mass with low echo and anechoic area was found in 1child with duodenal Brunner's gland adenoma.A mass with honeycomb microcystic margin was observed in 1child with mesenteric lymphangio-cavernoma.A heterogeneous hypoechoic mass was found in 1multiple polypoidal cavernous hemangioma child.A cystic mass with separation was found in 1 intestinal wall and mesentery vascular malformation child.An oval hypoechoic mass was detected in 1child with low grade malignant angiogenic tumor.Thickened intestinal wall and lacked blood supply was found in 10 hemorrhagic necrotizing enterocolitis children.Conclusion Ultrasonography can be used to confirm original disease of SI in children,therefore provide important basis for clinical diagnosis and treatment of SI.
Objective To observe ultrasonic manifestations of secondary intussusception(SI)in children.MethodsPreoperative ultrasonic features of 125 children with histopathologically proved SI were retrospectively analyzed.ResultsConcentric circle sign in transverse section,sleeve sign in longitudinal section and abnormal mass echoes in intussusception loop were found in all 125 children.Low echo mass with small or round-shaped anechoic area was found in 28 children with juvenile polyps and 2 with juvenile polyposis syndrome.Wheel-like mass,radial distribution or high and low echo interphase were detected in 19Peutz-Jeghers syndrome children,while cystic mass with thick wall showing "double ring" or "three ring" signs was found in 18 intestinal duplication children.Nodular changes or abnormal patterns of intestinal echo were observed in 17 children with Meckel's diverticulum.Obviously thick wall with rich blood supply was found in 11 children with allergic purpuras.Tubular hypoecho was detected in 6appendicitis children.An extremely hypoechoic mass with abundant blood was noticed in 5intestinal lymphoma children,while a mass of mixed echogenicity containing several small cystic areas was found in 2ileal adenomyoma children.A mass echo was found in 2lipoangioma children.A medium and high echo mass with low echo and anechoic area was found in 1child with duodenal Brunner's gland adenoma.A mass with honeycomb microcystic margin was observed in 1child with mesenteric lymphangio-cavernoma.A heterogeneous hypoechoic mass was found in 1multiple polypoidal cavernous hemangioma child.A cystic mass with separation was found in 1 intestinal wall and mesentery vascular malformation child.An oval hypoechoic mass was detected in 1child with low grade malignant angiogenic tumor.Thickened intestinal wall and lacked blood supply was found in 10 hemorrhagic necrotizing enterocolitis children.Conclusion Ultrasonography can be used to confirm original disease of SI in children,therefore provide important basis for clinical diagnosis and treatment of SI.
引文
[1]李动,赵宝泉.超声监视下水压灌肠治疗小儿急性肠套叠30例.中国医学影像技术,2009,25(S1):233-234.
[2]Zhang Y,Dong Q,Li SX,et al.Clinical and ultrasonographic features of secondary intussusception in children.Eur Radiol,2016,26(12):4329-4338.
[3]Wang X,Jia C,Yang H,et al.Sonographic features of a juvenile polyp:A case report and literature review.Clin Imaging,2014,38(2):215-217.
[4]苗莉莉,刘小芳,张新村,等.高频超声对儿童Peutz-Jeghers综合征的诊断价值.中华超声影像学杂志,2016,25(5):445-447.
[5]夏焙.小儿超声诊断学.北京:人民卫生出版社,2013:527.
[6]Bouassida M,Feidi B,Ben Ali M,et al.Intussusception caused by an inverted Meckel's diverticulum:A rare cause of small bowel obstruction in adults.Pan Afr Med J,2011,10:57.
[7]刘庆华,刘小芳,张新村,等.小儿消化道畸形639例的超声诊断分析.中华临床医师杂志(电子版),2013,7(21):9810-9813.
[8]田青,朱好辉,袁建军,等.超声与放射性核素显像诊断儿童梅克尔憩室的对比研究.中国医学影像技术,2017,33(7):998-1001.
[9]王秋莲,李春敏,苗润琴.儿童腹部淋巴瘤11例超声表现及误诊原因分析.肿瘤研究与临床,2017,29(21):123-125.
[10]张杰,刘庆华,刘小芳,等.超声诊断小儿先天性回肠腺肌瘤2例.中华超声影像学杂志,2017,26(2):125,131.
[11]Peloso A,ViganòJ,Vanoli A,et al.Saving from unnecessary pancreaticoduodenectomy.Brunner's gland hamartoma:Case report on a rare duodenal lesion and exhaustive literature review.Ann Med Surg(Lond),2017,17:43-49.
[12]辛悦,贾立群,王晓曼.儿童继发性肠套叠的超声表现.中华医学超声杂志(电子版),2011,8(5):1106-1115.
[13]魏淑萍,杨斌,徐超丽,等.常规超声检查及超声造影在克罗恩病诊断中的应用价值.中华医学超声杂志(电子版),2016,13(6):406-410.
[14]崔华,马进财,刘绍玲.小儿腹型过敏性紫癜的高频超声诊断价值探讨.医学影像学杂志,2016,26(10):1833-1836.
[15]陈文娟,张号绒,刘金桥,等.小儿肠套叠合并肠坏死的超声表现及诊断价值.中国当代儿科杂志,2008,10(2):161-162.
[2]Zhang Y,Dong Q,Li SX,et al.Clinical and ultrasonographic features of secondary intussusception in children.Eur Radiol,2016,26(12):4329-4338.
[3]Wang X,Jia C,Yang H,et al.Sonographic features of a juvenile polyp:A case report and literature review.Clin Imaging,2014,38(2):215-217.
[4]苗莉莉,刘小芳,张新村,等.高频超声对儿童Peutz-Jeghers综合征的诊断价值.中华超声影像学杂志,2016,25(5):445-447.
[5]夏焙.小儿超声诊断学.北京:人民卫生出版社,2013:527.
[6]Bouassida M,Feidi B,Ben Ali M,et al.Intussusception caused by an inverted Meckel's diverticulum:A rare cause of small bowel obstruction in adults.Pan Afr Med J,2011,10:57.
[7]刘庆华,刘小芳,张新村,等.小儿消化道畸形639例的超声诊断分析.中华临床医师杂志(电子版),2013,7(21):9810-9813.
[8]田青,朱好辉,袁建军,等.超声与放射性核素显像诊断儿童梅克尔憩室的对比研究.中国医学影像技术,2017,33(7):998-1001.
[9]王秋莲,李春敏,苗润琴.儿童腹部淋巴瘤11例超声表现及误诊原因分析.肿瘤研究与临床,2017,29(21):123-125.
[10]张杰,刘庆华,刘小芳,等.超声诊断小儿先天性回肠腺肌瘤2例.中华超声影像学杂志,2017,26(2):125,131.
[11]Peloso A,ViganòJ,Vanoli A,et al.Saving from unnecessary pancreaticoduodenectomy.Brunner's gland hamartoma:Case report on a rare duodenal lesion and exhaustive literature review.Ann Med Surg(Lond),2017,17:43-49.
[12]辛悦,贾立群,王晓曼.儿童继发性肠套叠的超声表现.中华医学超声杂志(电子版),2011,8(5):1106-1115.
[13]魏淑萍,杨斌,徐超丽,等.常规超声检查及超声造影在克罗恩病诊断中的应用价值.中华医学超声杂志(电子版),2016,13(6):406-410.
[14]崔华,马进财,刘绍玲.小儿腹型过敏性紫癜的高频超声诊断价值探讨.医学影像学杂志,2016,26(10):1833-1836.
[15]陈文娟,张号绒,刘金桥,等.小儿肠套叠合并肠坏死的超声表现及诊断价值.中国当代儿科杂志,2008,10(2):161-162.