Application value of combination of high and low frequency ultrasound in the diagnosis of intussusception in children
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摘要:
目的 探讨高低频超声结合在诊断小儿肠套叠中的应用价值。 方法 回顾性分析2018年6月~2021年6月本院收治的60例疑似肠套叠患儿的临床资料，均行高频和低频彩色多普勒超声检查，以手术病理为金标准，分析检查准确性、敏感度、特异性及影像学特征和血流信号，分析患儿具体治疗情况。 结果 60例肠套叠患儿中阳性52例，阴性8例，与临床诊断结果对照，高低频超声诊断小儿肠套叠的敏感度为86.54%，特异性为100.00%，准确性为86.15%。高低频超声诊断单纯性肠套叠、混合型性肠套叠及缺血型性肠套叠的准确率为93.75%、90.00%、100.00%；诊断回回结病变、回结病变、盲结病变、结结病变及小肠病变的准确率为80.00%、96.55%、100.00%、100.00%、100.00%。低频探头下，超声内部低回声包块，近端肠管呈扩张现象。高频探头下，包块边界清晰，横切面强弱相间回声，外周呈低回声，表现出“同心圆”征。纵切面强弱相间回声，前后低回声，呈“套筒征"，近侧肠管扩张。本组45例确诊肠套叠患儿中，有43肠套叠患儿在高频超声扫描中高低频超声血流声像图清晰，表现为条状及棒状血流；其余2例未发现异常血流信号，无法检测出频谱，对这2例实施手术或灌肠确诊为肠坏死。所有患儿在接受治疗后出现套叠的肠管均较好复位，症状得到了较好缓解，未出现其他不适反应。 结论 高低频超声可提高小儿肠套叠诊断准确性、敏感度和特异性，明确肠套叠类型、部位、超声成像特征及血流信号。 Abstract:Objective To explore the application value of high and low frequency ultrasound in the diagnosis of intussusception in children. Methods The clinical data of 60 children suspected of intussusception in the hospital were retrospectively analyzed from Jun 2018 to Jun 2021. All patients underwent high frequency and low frequency color Doppler ultrasound examination, and the operation pathology was the gold standard. Accuracy, sensitivity, specificity, imaging characteristics and blood flow signals were analyzed, and the specific treatment of the children was analyzed. Results Clinical diagnosis results showed 52 positive cases and 8 negative cases in the 60 children with intussusception. Compared with clinical diagnosis results, the sensitivity, specificity, and accuracy of high-frequency two-dimensional ultrasound and color Doppler ultrasound in diagnosing intussusception in children were 86.54%, 100.00% and 86.15%, The diagnostic accuracy rates of simple, mixed and ischemic intussusception were 93.75%, 90.00% and 100.00% by high and low frequency ultrasound.The accuracy of the diagnosis of gyronodal lesions, gyronodal lesions, caecal nodal lesions, nodal lesions and small intestinal lesions were 80.00%, 96.55%, 100.00%, 100.00%, 100.00%. Under low frequency probe, low echo mass and distention of proximal intestine were found in ultrasound. Under the high frequency probe, the boundary of the lumps is clear, the transverse section is alternating with strong and weak echo, and the periphery is low echo, showing "concentric circle" sign. Longitudinal section of strong and weak alternate echo, anterior and posterior low echo, showing a "sleeve sign", proximal intestinal dilatation. Of the 45 children diagnosed with intussusception in this study, 43 had clear blood flow images in high frequency ultrasound scan, showing striped and rod-shaped blood flow. The remaining 2 cases showed no abnormal blood flow signals, and the spectrum could not be detected, which indicated the probability of intestinal necrosis. Finally, the 2 cases were diagnosed as intestinal necrosis by surgery or enema. Under the guidance of color Doppler ultrasound, 45 cases were reset with normal saline enema. After treatment, all the children had better reduction of the intussed bowel, and their symptoms were better relieved, without other uncomfortable reactions. Conclusion High and low frequency ultrasound can improve the accuracy, sensitivity and specificity of the diagnosis of intussusception in children, and clarify the type, location, ultrasonic imaging characteristics and blood flow signal of intussusception. -
图 1 肠套叠患儿超声征象
A: 外周呈“同心圆”征; C: 前后呈“套筒征; B、D: 血流呈条状.
Figure 1. Ultrasound signs of children with intussusception.
表 1 高低频超声诊断结果
Table 1. Diagnosis results of high and low frequency ultrasound(n)
高低频超声 手术病理诊断 合计 阳性（n=52） 阴性（n=8） 阳性 45 0 45 阴性 7 8 15 合计 52 8 60 
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表 2 高频和低频彩色多普勒超声对不同病变类型检出率
Table 2. Detection rates of different lesion types by high-frequency and low-frequency color Doppler ultrasound[n(%)]
高低频超声 手术病理诊断 单纯性肠套叠（n=32） 混合型性肠套叠（n=10） 缺血型性肠套叠（n=3） 单纯性肠套叠 30（93.75） 2（6.25） 0（0.00） 混合型性肠套叠 1（10.00） 9（90.00） 0（0.00） 缺血型性肠套叠 0（0.00） 0（0.00） 3（100.0）
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表 3 高频和低频彩色多普勒超声对不同病变部位检出率
Table 3. Detection rate of high-frequency and low-frequency color Doppler ultrasound in different lesion sites[n(%)]
高低频超声检查 手术病理诊断 回回结（n=5） 回结（n=29） 盲结（n=6） 结结（n=3） 小肠（n=2） 回回结 4（80.00） 0（0.00） 0（0.00） 0（0.00） 0（0.00） 回结 0（0.00） 28（96.55） 0（0.00） 0（0.00） 0（0.00） 盲结 0（0.00） 0（0.00） 6（100.0） 0（0.00） 0（0.00） 结结 0（0.00） 0（0.00） 0（0.00） 3（100.0） 0（0.00） 小肠 0（0.00） 0（0.00） 0（0.00） 0（0.00） 2（100.0）
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