高频超声对228例小儿结直肠息肉的诊断价值(1)
【摘要】 目的 探讨超声检查对小儿结直肠息肉的声像图特点及其诊断价值。方法 228例怀疑结直肠息肉患儿， 选择常规超声或结合生理盐水灌肠后超声检查， 以结肠镜活检组织病理检查结果为金标准， 分析结直肠息肉患儿的超声声像图特点及其敏感度和特异度。结果 228例患儿中结肠镜检出息肉228例， 单发201例， 多发27例。228例患儿中超声诊断准确212例， 超声诊断的总敏感度为93%(212/228)， 对直径15～35 mm、≥35 mm的敏感度分别为96%(105/109)、100%(61/61)， 均明显高于直径≤15 mm的79%(46/58)， 差异有统计学意义(P<0.01);直径15～35 mm与直径≥35 mm的敏感度比较， 差异无统计学意义(P>0.05)。腹部高频彩色多普勒超声检查息肉漏诊16例， 2例诊断为淋巴瘤， 4例诊断为淋巴结， 10例未检出(其中8例息肉直径<15 mm， 2例位于结肠脾曲);10例合并肠套叠患儿中， 5例超声图像诊断为息肉， 4例误诊为淋巴结， 1例漏诊。结论 结直肠息肉具有典型的声像图特征， 腹部超声对小儿结直肠息肉有较高的检出率， 可作为小儿结直肠息肉的首选检查方法之一。
【关键词】 超声;小儿 ;结直肠息肉;诊断;漏诊
【Abstract】 Objective To discuss the ultrasonographic characteristics of colorectal polyps in children and its diagnostic value. Methods 228 children suspected of colorectal polyps were examined by conventional ultrasound or ultrasound examination after normal saline enema. The results of colonoscopy biopsy were taken as the gold standard to analyze the sonographic characteristics， sensitivity and specificity of children with colorectal polyps. Results Among 228 children， 228 polyps， 201 single polyps and 27 multiple polyps were detected by colonoscopy. Among 228 children， 212 cases were accurately diagnosed by ultrasound. The total sensitivity of ultrasound diagnosis was 93% (212/228)， and the sensitivity to diameters of 15 - 35 mm and ≥35 mm were 96% (105/109) and 100% (61/61)， respectively， which were significantly higher than 79% (46/58) of diameter ≤15 mm， and the difference was statistically significant (P<0.01). There was no significant difference in sensitivity between 15-35 mm diameter and ≥ 35 mm diameter (P>0.05). 16 cases of polyps were missed diagnosed in abdominal high frequency color Doppler ultrasound， of which 2 cases were diagnosed as lymphoma， 4 cases were diagnosed as lymph nodes， and 10 were undetected (of which 8 cases had a polyp diameter of <15 mm， and 2 cases were located in the colonic spleen). Of the 10 children with intussusception， 5 cases were diagnosed as polyps by ultrasound images， 4 cases were misdiagnosed as lymph nodes， and 1 case was missed. Conclusion Colon polyp has typical sonographic characteristics. Abdominal ultrasound has a high detection rate of colorectal polyp in children. It can be used as one of the preferred examination methods of colorectal polyp in children.
【Key words】 Ultrasound; Children; Colorectal polyps; Diagnosis; Missed diagnosis
結直肠息肉是小儿常见病， 也是小儿便血的常见原因。直肠指诊、结肠镜或X线气钡灌肠是诊断结直肠息肉的常用方法。尤其结肠镜检查是目前诊断的金标准， 但其属于侵入性有创检查。另外CVVC、MRVC也是近几年开展起来的无创性检查方法， 可发现直径>0.5 cm的息肉， 可对整个结肠进行扫描， 是多发性息肉诊断的可靠手段， 但都有其局限[1]。超声检查是一种安全、无创、简便易行的检查手段， 超声检查结直肠息肉具有典型的声像图特征， 和结肠镜检查差异没有显著的意义[2]。但超声检查对小儿结直肠息肉的诊断报道较少。本研究旨在分析228例小儿结直肠息肉的高频超声表现， 探讨超声检查对小儿结直肠息肉的实际应用价值， 提高超声检查对小儿结直肠息肉的诊断率， 为临床诊断和治疗小儿结直肠息肉提供影像学依据。, 百拇医药(王俊玲)
【关键词】 超声;小儿 ;结直肠息肉;诊断;漏诊
【Abstract】 Objective To discuss the ultrasonographic characteristics of colorectal polyps in children and its diagnostic value. Methods 228 children suspected of colorectal polyps were examined by conventional ultrasound or ultrasound examination after normal saline enema. The results of colonoscopy biopsy were taken as the gold standard to analyze the sonographic characteristics， sensitivity and specificity of children with colorectal polyps. Results Among 228 children， 228 polyps， 201 single polyps and 27 multiple polyps were detected by colonoscopy. Among 228 children， 212 cases were accurately diagnosed by ultrasound. The total sensitivity of ultrasound diagnosis was 93% (212/228)， and the sensitivity to diameters of 15 - 35 mm and ≥35 mm were 96% (105/109) and 100% (61/61)， respectively， which were significantly higher than 79% (46/58) of diameter ≤15 mm， and the difference was statistically significant (P<0.01). There was no significant difference in sensitivity between 15-35 mm diameter and ≥ 35 mm diameter (P>0.05). 16 cases of polyps were missed diagnosed in abdominal high frequency color Doppler ultrasound， of which 2 cases were diagnosed as lymphoma， 4 cases were diagnosed as lymph nodes， and 10 were undetected (of which 8 cases had a polyp diameter of <15 mm， and 2 cases were located in the colonic spleen). Of the 10 children with intussusception， 5 cases were diagnosed as polyps by ultrasound images， 4 cases were misdiagnosed as lymph nodes， and 1 case was missed. Conclusion Colon polyp has typical sonographic characteristics. Abdominal ultrasound has a high detection rate of colorectal polyp in children. It can be used as one of the preferred examination methods of colorectal polyp in children.
【Key words】 Ultrasound; Children; Colorectal polyps; Diagnosis; Missed diagnosis
結直肠息肉是小儿常见病， 也是小儿便血的常见原因。直肠指诊、结肠镜或X线气钡灌肠是诊断结直肠息肉的常用方法。尤其结肠镜检查是目前诊断的金标准， 但其属于侵入性有创检查。另外CVVC、MRVC也是近几年开展起来的无创性检查方法， 可发现直径>0.5 cm的息肉， 可对整个结肠进行扫描， 是多发性息肉诊断的可靠手段， 但都有其局限[1]。超声检查是一种安全、无创、简便易行的检查手段， 超声检查结直肠息肉具有典型的声像图特征， 和结肠镜检查差异没有显著的意义[2]。但超声检查对小儿结直肠息肉的诊断报道较少。本研究旨在分析228例小儿结直肠息肉的高频超声表现， 探讨超声检查对小儿结直肠息肉的实际应用价值， 提高超声检查对小儿结直肠息肉的诊断率， 为临床诊断和治疗小儿结直肠息肉提供影像学依据。, 百拇医药(王俊玲)
参见：首页 > 医疗版 > 疾病专题 > 胃肠外科 > 直肠、肛管疾病 > 直肠息肉