| 摘要: |
| [摘要] 目的 探讨小儿先天性胃窦隔膜口服胃造影前后的超声成像特征，并分析漏误诊原因。方法 回顾性分析2012年1月至2020年6月我院经外科手术、胃镜手术及病理检查确诊为胃窦隔膜患儿的临床、超声（US）、上消化道造影（UGI）及胃镜检查（EGD）等资料，结合病理分析声像图特征、US漏误诊原因。结果 共纳入24例手术确诊患儿，男20例，女4例，表现为反复非胆汁性呕吐23例（95.83%）。超声漏诊15例（62.50%），误诊1例（4.17%），胃腔造影8例（33.33%）。8例US诊断胃窦隔膜（33.33%，常规超声仅2例，造影后8例)。常规超声声像图特征：直接征象：垂直于胃窦前后壁的窄条状低回声，胃窦局部缩窄、幽门开放受限。间接征象：胃潴留18例（75.00%），幽门开放困难，3例（37.50%，3/8）伴有幽门肌层水肿增厚。口服造影声像图特征：直接征象：隔膜呈“高-低-高”窄条状三线回声结构，长0.8-1.2cm，厚0.18-0.6cm，不同位置所示形态不同，胃窦部（6例）：垂直于胃窦长轴的条状结构，4例可见隔膜上小孔，呈中央型或偏心型，孔径大小0.13～0.5cm；幽门部（2例）：幽门管内粘膜冗余折叠、水肿增厚，呈瓣膜样或“乳头征”。结论 胃窦局部缩窄、幽门开放受限及垂直胃窦前后壁的低回声条状结构等特征的识别有助于提高胃窦隔膜常规超声筛查的确诊率及胃造影率，胃腔造影后可显示隔膜结构及孔隙，利于梗阻程度的判断及早期治疗。 |
| 关键词: 超声检查，胃窦隔膜，儿童 |
| DOI： |
| 投稿时间：2021-05-26修订日期：2021-05-26 |
| 基金项目: |
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| Ultrasonographic features of congenital antral septum in children |
| zhulirong,yangchunjiang |
| (Children＇s Hospital of Chongqing Medical University) |
| Abstract: |
| Objective To investigate the ultrasonographic features features of congenital gastric antrum septum in children before and after oral administration of contrast agent, and to analyze the causes of missed diagnosis and misdiagnosis. Methods Children diagnosed with congenital antral septum by surgery and pathological examination in our hospital between January 2012 and June 2020 were collected. Their clinical characteristics and the results of ultrasound, upper gastrointestinal contrast, gastroscopy and histopathological examination were retrospectively analyzed. The sonographic characteristics of ultrasound diagnosis were summarized, the causes of missed diagnosis and misdiagnosis were also analyzed. Results A total of 24 children were included, including 20 male and 4 female; The main clinical manifestation was recurrent non-biliary vomiting (23 cases, 95.83%). 8 cases (33.33%) of gastric antral septum were accurately diagnosed by ultrasonography, 15 cases (62.50%) were missed and 1 case (4.17%) was misdiagnosed; Among them, only 2 cases were accurately diagnosed without oral contrast agent, and 8 cases (including those 2 cases already diagnosed) were accurately diagnosed after taking contrast agent. Under contrast-free ultrasound, the gastric antrum septum presented as a narrow strip of low echo perpendicular to the anterior and posterior walls of gastric antrum, with local narrowing of gastric antrum; Under contrast-enhanced ultrasound, the septum was a narrow strip with "high-low -high" three line echo structure, which was 0.8-1.2 cm in length and 0.18-0.6 cm in thickness; The diaphragms in different positions presented different shapes. Diaphragms in gastric antrum (6 cases) presented as strip structure vertical to the long axis of the gastric antrum. A central or eccentric apertures, whose size ranged from 0.13 to 0.5 cm, was observed in the diaphragm (4 cases). Diaphragms in the pylorus (2 cases) looked like redundantly folded mucosa, which was edematous and thickened and with fixed shape, forming the "Nipple sign". Ultrasound also identified some indirect signs of gastric antrum septum, including gastric retention (18 cases, 75%), narrowed pyloric opening, and thickening of pyloric muscle layer (3 cases, 37.50% ). Conclusion The identification of hypoechoic strip structure, local narrowing of gastric antrum, limited opening of pylorus and edema and thickening of pylorus myometrium would be very helpful in the initial screening of gastric antrum septum by routine ultrasound examination. Further detection with contrast-enhanced ultrasound can show the structure and apertures of the diaphragm, which is critical to the confirmation of the diaphragm and the judgment of the degree of gastric antral obstruction, and finally greatly promotes the early diagnosis and early intervention of this pediatric disease. |
| Key words: ultrasonography, congenital antral septum, children |
