摘要
目的探讨经腹部超声辅以口服20%甘露醇肠道充盈法或(和)经肛门结肠灌水法诊断回盲瓣综合征(IVS)的临床价值。方法对37例IVS患者各种超声声像图表现进行总结,并与保守治疗后复查及手术病理检查结果对照分析。结果 37例IVS患者保守治疗后复查及手术病理检查证实特发性IVS28例(75.7%,28/37),继发性IVS9例(24.3%,9/37,原发病包括急性阑尾炎5例、Meckel憩室2例、末端回肠炎1例、升结肠癌1例),超声诊断符合率为89.2%(33/37),误诊率为10.8%(4/37,特发性IVS1例,继发性IVS3例)。37例IVS患者超声图像以7.0～10.0MHz线阵探头显示清楚,空腹时检查可见3种特征性超声征象,均见于右下腹回肠末段至回盲瓣区,其中"面包圈征"显示率91.9%(34/37),平均大小(1.9±1.6)cm×(0.8±0.3)cm;"短套袖样征"显示率91.9%(34/37),平均大小(2.1±0.4)cm×(1.3±0.2)cm;"玫瑰花结状征"显示率83.8%(31/37),平均大小(1.4±0.2)cm×(1.0±0.2)cm,探头加压后部分征象形态可变。特发性IVS患者经20%甘露醇肠道充盈法可显示回肠末段黏膜层及黏膜下层轻微增厚,管壁柔软;回盲瓣增大,图像典型者增大的回盲瓣呈"鳄鱼嘴样"伸向结肠腔内。结论经腹部高频超声辅以20%甘露醇小肠充盈法检查对IVS诊断及鉴别诊断有重要作用,方法简便、准确,值得推广应用。
Objective To discuss the clinical value of transabdominal sonography after bowl preparation in diagnosis of ileocecal valve syndrome (IVS).Methods The ultrasonic features of IVS in 37 cases were summerized and correlated with the follow-up findings after conservative treatment or the pathologic results after operation.Twenty-eight cases were confirmed by follow-up and 9 cases by operative pathology.Results Among the 37 cases of IVS,28 were idiopathic IVS(75.7%,28/37) and 9 were secondary IVS (24.3%,9/37%).For the secondary cases,the primary diseases included 5 acute appendicitis,2 Meckel diverticulum,1 terminal ileitis and 1 carcinoma of ascending colon.The diagnostic accuracy rate of ultrasound was 89.2% (33/37).Misdiagnosis rate was 10.8% (4/37),including 1 case of idiopathic and 3 cases of secondary IVS.The IVS ultrasonic images coulde be displayed clearly using 7.0-10.0 MHz probes.In fasting examination,three ultrasonic characteristic signss were found in interminal ileum region at the right lower abdomen.And these features were bagel-shaped sign [91.9%(34/37),average size (1.9±1.6)cm×(0.8±0.3)cm],short sleevelet-shaped sign [91.9% (34/37,average size (2.1±0.4)cm×(1.3±0.2)cm],and rose-shaped sign [83.8% (31/37),average size (1.4±0.2)cm×(1.0±0.2)cm].The shapes of some signs were changeable when the probe compressed.In the case of idiopathic IVS,several pathologic changes could be seen on sonography after intestinal tract filling of oral 20% mannitol,including slight thickened mucosa and submucosa of erminalileum,enlarged ieocecal valve and the crocodile-mouth sign.Conclusions Transabdominal ultrasonic examination with high frequency probe after bowl preparation plays an important role in diagnosis of IVS.The method is simple and accurate and should be recommended and applied clinically.
出处
《中华医学超声杂志（电子版）》
2013年第7期568-576,共9页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
安徽省淮北市科技计划项目(080241)
关键词
超声检查
回盲瓣
回肠疾病
盲肠疾病
诊断
Ultrasonography
Ileocecal valve
Ileal diseases
Cecal diseases
Diagnosis
