儿童急腹症的超声检查

1、Sonography of the Surgical Abdomen in ChildrenKEYWORDS Adolescents Appendicitis Malrotation UltrasoundWith the introduction of the graded-compression sonographic technique and continued advances in ultrasound technology, the use of sonography has increased in the evaluation of the child who has a su

2、spected surgical abdomen. The principalrole of sonography is to characterize the nature of the many conditions associated with acute abdominal symptoms and signs and to differentiate between those requiring urgent surgical intervention and those that do not. This article reviewsthe sonographic evalu

3、ation of common important surgical conditions of the abdomen in children. Indications for performing sonography, sonographic features of common lesions, and the sonographic techniques best suited to making a diagnosis areaddressed. 儿童急腹症的超声检查关键词 青少年 阑尾炎 旋转不良 超声随着分级加压超声检查技术的介绍及超声技术的不断前进，超声在评价可疑有急腹症的儿

4、童中的作用已逐步增加。超声的首要角色是表示出那些与急腹症状及征象有关的情况的本质特征，并且区分出哪些需要外科手术及哪些不需要外科手术。本文对儿童腹部普通的而又重要的具有外科条件的超声评价进行了综述。超声应用的指征，普通病变的超声特征及用于诊断的最佳超声技术均在本文提及。 如果你赞同本文的内容, 可以给作者, 你在连续七天内最多可以投3票, 今天可最多投3票. mengxuebinglin edited on 2010-02-21 21:38 HYPERLINK javascript:report_abuse(16621675) 举报 HYPERLINK :/ dxy /bbs/post/vie

5、w?bid=113&id=16696774 t _blank 【讨论】浅谈老年人的眼部整形及其它（杂谈） mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/

6、 dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-21 21:13 初次翻译，不当处请朋友多多指教，谢谢！ HYPERLINK javascript:report_abuse(16621735) 举报 HYPERLINK :/ dxy /bbs/post/view?bid=144&id=16693752 t _blank 【原创】充分认识手术安全现状 加强手术安全管理 mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?user

7、name=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-21 21:17 HYPERLINK :/ dxy

8、/bbs/actions/rate_post?id=16621754&bid=197&action=ListAll t _blank 得票1 ULTRASOUNDTECHNIQUESKnowledge of the patients symptoms, physical findings, and laboratory data is important to focus the examination and increase the likelihood of a correct diagnosis. If the pain is located in the right upper qu

9、adrant, the sonogram should focus on the liver, gallbladder, biliary ducts, pancreas, and right kidney. If the pain is in the right lower quadrant, the appendix, small bowel, and pelvicorgans should be interrogated in detail. These distinctions are somewhat artificial, but they can serve as a guidel

10、ine to investigating acute abdominalpain in children. When the pain is in other locations, the examination should be tailored to these areas.超声技术掌握病人的症状，体格检查及实验室数据是很重要的，可以集中在检查点并提高正确检查的可能性。如果疼痛位于右上腹部，超声图像应集中看肝，胆囊，胆管，胰腺和右肾。如果疼痛位于右下腹部，盲肠，小肠和骨盆器官应该详细检查。这些区分多少有点是人工假设的，但能够在检查儿童急腹症疼痛中充当一个准则。如果疼痛位于其他位置，检查也

11、要相应的置于这些特定区域。 /bbs/actions/rate_post?id=16621754&bid=197&action=ListAll t _blank 查看所有投票本贴已得 1 同行票!mengxuebinglin edited on 2010-02-21 21:30 HYPERLINK javascript:report_abuse(16621754) 举报 t _blank 【讨论】协和出版社李春宇副社长答疑：协和2010医师资格考试用书有哪些优势？ mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=meng

12、xuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-21 21:25 Graded-Compression Sonogra

13、phyThe graded compression technique is used in the evaluation of suspected appendicitis, acute bowel diseases, and mesenteric adenitis.1,2 A linear- orcurved-array transducer (5 or 7.5 MHz) is used to compress the right lower quadrant gradually. Gentle, gradual pressure is applied to the anterior ab

14、dominal wall, resulting in displacement and compression of normal bowel loops. At the startof the examination, the patient is asked to point with a single finger to the site of maximal tenderness or pain.3 This localization expedites the search for an inflamed appendix, especially an aberrantly loca

15、ted appendix, and reduces the time of the examination.分级加压超声检查法分级加压检查技术被用来评价可疑阑尾炎，急性肠道疾病及肠系膜淋巴结炎。线阵的或扇形的探头用来逐步加压右下腹部。轻轻的逐步的压力作用于前腹壁可导致正常肠袢的位置移动和受压。检查开始，要让病人用单个手指指出压痛或疼痛最大的点。这种定位可以加速派遣向阑尾炎症的扫查，尤其是位置异常的阑尾，可以缩短检查时间。 mengxuebinglin edited on 2010-02-21 21:31 HYPERLINK javascript:report_abuse(16621821) 举

16、报 ?bid=119&id=14039074 t _blank 【眼整形讨论】少见的眼面部血管瘤 mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy

17、 /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-21 21:28 Scanning begins in the transverse plane with identification of the ascending colon, which appears as a nonperistaltic structure containing gas and fluid. The transducer then is moved inferiorly to identify the ce

18、cal tip, where the appendix should arise. Pressure is applied gradually to the cecal tip, which displaces gas and fecal material from the cecum and enhances visualization of the appendixand distal small bowel. The normal terminal ileum is easily compressible and displays active peristalsis. The psoa

19、s muscle and external iliac vessels should be identified also, because the appendix lies anteriorly to these structures. Gray-scale and color Doppler images are acquired.扫查以鉴定升结肠的切面开始，升结肠是以包含有气体及液体的不蠕动的结构出现。然后探头向下移向盲肠尖端，这里可能有阑尾出现。逐步向盲肠尖端加压，可以将来自盲肠的气体和粪便类物质赶走并加强阑尾和远端小肠的显示效果。正常的回肠末端是容易压缩的并能够展示活跃的蠕动。腰肌

20、和髂外血管应该能够鉴别出，因为阑尾就位于这些结构的前面。要获取灰阶及彩色多普勒图像。 mengxuebinglin edited on 2010-02-21 21:32 HYPERLINK javascript:report_abuse(16621844) 举报 s/post/view?bid=50&id=16690201 t _blank 颈椎病，先天性阻滞椎请教手术方案 mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ d

21、xy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-21 21:36 Pelvic SonographySonographic assessment of pelvic pathology in children

22、is performed with a transabdominal approach using a distended urinary bladder as the acoustic window. The distended bladder displaces gas-filled bowel loops out of the pelvis,allowing transmission of sound into deeper structures of the pelvis and easier visualization of the ovaries and uterus. In mo

23、st children adequate bladder filling can be achieved with oral intake of fluid. Bladder catheterization with instillation of sterile fluid may be required if the patient is unable to tolerate large fluid volumes orally. In some instances, placing the patient in a decubitus position and scanning dire

24、ctly over the adnexa will improve visualization of the ovaries. Pelvic sonography is performed with a sector or curved-array transducer.Scans of the pelvic organs are obtained in both the sagittal and transverse planes. Grayscale and color Doppler images are acquired.4骨盆的超声检查儿童骨盆病理学的超声评估是利用膨胀的膀胱作为透声

25、窗进行经腹检查来完成的。膨胀的膀胱可以赶走位于盆腔的充满气体的肠道，从而使得超声可以透射盆腔更深的结构同时使卵巢和子宫更易显示。大部分儿童的膀胱适度充盈通过口服液体即可完成。如果患儿不能忍受口服大量液体，可以通过膀胱导尿术灌注消毒的液体。在有些情况下，让病人卧位并且直接扫查附件位置可以提高卵巢的显示效果。骨盆的超声检查是用扇形或弯曲排列的探头完成的。骨盆器官的扫查可以通过纵切及横切面获得。要获取灰阶及彩色多普勒图像。 HYPERLINK javascript:report_abuse(16621896) 举报 HYPERLINK :/ dxy /bbs/post/view?bid=57&id=

26、16625138&sty=1&tpg=1&age=0 t _blank 【招聘】安徽省巢湖市巢城中心医院诚聘各医学专业人才bitter发贴: HYPERLINK :/ dxy /bbs/post/search?username=bitter&action=Search 670 积分: HYPERLINK :/ dxy /bbs/user/info?uid=306194&action=ListScored 27 得票: HYPERLINK :/ dxy /bbs/user/info?uid=306194&action=ListVoted 5 状态: 隐身 HYPERLINK :/ dxy /bb

27、s/user/info?uid=306194 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=bitter t _blank 发短消息 2010-02-22 15:12 期待，请继续！ HYPERLINK javascript:report_abuse(16625350) 举报 HYPERLINK :/ dxy /bbs/post/view?bid=53&id=16692639 t _blank 【动态】总理报告：积极稳妥推进医药卫生体制改革 mengxuebinglin发贴: HYPERLINK

28、:/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-0

29、2-22 20:10 Endovaginal sonography is an alternative technique in pubertal females who use tampons or who are sexually active. A major advantage of endovaginal over transabdominal scanning is the obviation of bladder filling. The major limitation of this technique is a limited field of view. Because

30、of this problem, transabdominal sonography is used as the initial examination if the patient has not had a previous pelvic sonogram. An endovaginal study can be done if the transabdominal findings are indeterminate or confusing or to characterize ovarian and tubal pathology better.4对于用过填塞物或性生活活跃的青春期

31、女性，阴道超声检查可以作为一个替代技术。阴道超声优于经腹超声的一个主要优点是避免充盈膀胱。这个技术的主要局限性是观察视野的受限。由于这个问题，经腹超声检查被用作检查以前没有做过骨盆超声检查的病人的首要方法。如果经腹的检查所见是不定的，困惑的或者要更好地表现卵巢和输卵管的病状可以应用经阴道超声来进行研究。 mengxuebinglin edited on 2010-02-22 20:27 HYPERLINK javascript:report_abuse(16627027) 举报 HYPERLINK :/ dxy /bbs/post/view?bid=197&id=16668842 t _bla

32、nk 【请教】右下腹包块？ mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMess

33、age&to=mengxuebinglin t _blank 发短消息 2010-02-22 20:14 Scrotal SonographyScrotal sonography is performed with the patient in the supine position and the scrotum gently elevated and supported by towels placed between the thighs.5 A high-frequency linear-array transducer is used to maximize resolution o

34、f the scrotal contents. The scrotum and its contents are scanned in both transverse and longitudinal planes. Both hemiscrota should be examined, so that differences in the size and echogenicity of the intrascrotal contents can be recognized. Bothgray-scale and color and pulsed Doppler images are acq

35、uired.阴囊的超声检查阴囊的超声检查是在病人仰卧位的条件下进行，同时阴囊要轻轻鼓起并用毛巾放在大腿之间起支持作用。要用高频的线阵探头以使阴囊内容物的分辨率达到最大。阴囊及内容物要横切与纵切并用。半睾丸膜也应检查，以区分出阴囊内容物的大小及回声的不同。要获取灰阶，彩色及脉冲多普勒图像。 mengxuebinglin edited on 2010-02-22 20:28 HYPERLINK javascript:report_abuse(16627049) 举报 HYPERLINK :/ dxy /bbs/post/view?bid=12&id=16615908 t _blank 【讨论】20

36、10报考第四军医大学的同学们晒晒成绩吧 mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=Wri

37、teMessage&to=mengxuebinglin t _blank 发短消息 2010-02-22 20:20 SURGICAL ABDOMINALCONDITIONSThe most frequent disorders requiring acute surgical intervention in children are acute appendicitis and pyloric stenosis.611 Other conditions include malrotation, intussusception, and acute ovarian and scrotal di

38、sorders.16 The differential diagnosis often can be narrowed based on the patients age, the type and location of the pain, the presence or absence of other signs and symptoms, and pertinent laboratory data. Even when these factors are considered, it often is not possible to make a specific diagnosis,

39、 and imaging studies, such as sonography, are needed to ensure a correct diagnosis and prompt treatment.腹部的外科情况在儿童中最盛行的要求急性外科手术的疾病是急性阑尾炎和幽门狭窄。其他的情况包括旋转不良，消化问题，急性卵巢和阴囊的疾病。根据病人的年龄，疼痛的类型及定位，其他症状和体征的出现和消失以及病人的实验室数据可缩小鉴别诊断的范围。只要这些因素都考虑了，做出一个特异性的诊断并不是不可能的，研究图像，比如超声，对于做出正确的诊断及迅速的治疗也是必需的。 HYPERLINK javascri

40、pt:report_abuse(16627094) 举报 HYPERLINK :/ dxy /bbs/post/view?bid=12&id=16615908 t _blank 【讨论】2010报考第四军医大学的同学们晒晒成绩吧 mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLIN

41、K :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-22 20:37 MIDGUTMALROTATIONMalrotation is an urgent diagnosis in infants, particularly when there is associated midgut volvulus. 6 During fetal development,

42、 the duodenojejunal junction and the cecum undergo 270 rotation, resulting in retroperitoneal fixation of the duodenojejunal junction in the left upper quadrant at the ligament of Treitz and the cecum in the right lower quadrant. At the completion of rotation, the small bowel is suspended from a bro

43、ad mesentery, which extends between the ligament of Treitz and the ileocecal valve. The term malrotation refers to a spectrum of incomplete rotation abnormalities,including failure of rotation (colon to the left, small bowel to the right), reverse nonrotation (small bowel to the left, colon to the r

44、ight), and incomplete rotation (a range of abnormalities between nonrotation and normal rotation). In malrotation, the attachment of the bowel is abnormally short, resulting in a narrowed mesenteric pedicle and an abnormally positioned ligament of Treitz.旋转不良是婴儿的一个急症，尤其是伴有中肠旋转不良。在胚胎发育过程中，十二指肠空肠连接和盲肠

45、要经历270度的旋转，导致两者在腹膜后固定，其中十二指肠空肠连接位于左上象限Treitz 悬韧带位置，盲肠位于右下象限。在旋转过程中，小肠是被宽大的肠系膜悬吊着，肠系膜可以在 Treitz 悬韧带和回盲瓣之间延伸。旋转不良一词涉及一系列旋转不良的异常情况，包括旋转失败（结肠位于左侧，小肠位于右侧），不转位但反位（小肠位于左侧，结肠位于右侧），以及旋转不全（不转位和正常旋转之间的一系列异常）。在旋转不良中，肠的附着异常的短，导致肠系膜蒂狭窄及Treitz悬韧带的异位。 HYPERLINK javascript:report_abuse(16627231) 举报 HYPERLINK :/ dxy

46、/bbs/post/view?bid=57&id=16672552 t _blank 【招聘】山东大学齐鲁医院关于2010年毕业生招聘及人才引进的通知 mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _

47、blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-22 20:44 Patients who have incomplete rotation have a high frequency of duodenal obstruction caused by peritoneal bands (Ladd bands) extramurally compressing the duodenum, midgut volvulus, or a

48、combination of these abnormalities. Ladd bands represent an attempt at fixation of the incompletely rotated bowel, and they obstruct the second and third portions of the duodenum as they pass from the alpositioned cecum to the posterior peritoneum or lateral abdominal wall. The more serious complica

49、tion of midgut malrotation is volvulus, which predisposes a patient to bowel ischemia and infarction. Approximately 80% to 90% of patients who have malrotation present in the first month of life with vomiting, which nearly always is bilious. Older children can present with a malabsorption syndrome c

50、ausedby mesenteric lymphatic stasis or with intermittent abdominal pain and vomiting from episodic volvulus.有旋转不良的病人会有频率极高的十二指肠梗阻，这是由腹壁外的十二指肠旁索带压迫十二指肠，中肠旋转不良或者这些异常问题的联合导致的。十二指肠旁索带代表着在不全旋转的肠的固定中的一种尝试，这些索带能够妨碍十二指肠的第二和第三部分在通过异位的盲肠时到达后腹膜或侧腹壁。中肠旋转不良的更严重的并发症是肠扭转，肠扭转能够使病人肠缺血和坏死。大约80%到90%有旋转不良的病人在生后一月内伴有呕吐，

51、呕吐物几乎全是胆汁。大一点的孩子可以伴有由肠系膜淋巴管淤滞或周期性的腹痛和片段的肠扭转所致的呕吐所导致的吸收不良综合征。 HYPERLINK javascript:report_abuse(16627289) 举报 HYPERLINK :/ dxy /bbs/post/view?bid=57&id=16666998 t _blank 【政策】2010年3月1日上海官方细则 mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dx

52、y /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 状态: 离线 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-22 20:52 The upper gastrointestinal examination is the principal imaging study for

53、 evaluating an infant with bilious vomiting and suspected malrotation. If the significance of the bile-stained vomitus is not appreciated, however, a sonogram may be the first examination requested, and thus the radiologist should be familiar with the sonographic findings of malrotation. Normally, t

54、he origin of thesuperior mesenteric artery lies to the left of the superior mesenteric vein, just distal to its union with the splenic vein to form the portal vein and just caudal to the pancreas. Reversal of this relationship suggests midgut malrotation.12,13 The relationship between these two vess

55、els is assessed best with transverse images, scanning above the pancreas and moving the transducer in a caudal direction. Spectral Doppler analysis is useful to confirm the relationship of the vessels (Fig. 1). Although vessel inversion is a sign of malrotation, this sign has limited sensitivity and

56、 specificity.14 Inversion of the mesenteric vesselshas been noted in 53% to 87% of children who have midgut malrotation; conversely, the prevalence of malrotation with vessel inversion has ranged from 6% to 100%.12,13 The accuracy of sonography does not warrant its use as the primary imaging study t

57、o diagnose or exclude the presence of malrotation, and the upper gastrointestinal series remains the study of choice for diagnosing this abnormality.对于评估有胆汁性呕吐和可疑旋转不良的婴儿来说上胃肠道的检查是首要的图像研究法。如果具有胆汁颜色的呕吐物的重要性不被重视，超声显像应该是首要检查，同时放射科医生应该熟悉旋转不良的超声检查所见。通常肠系膜上动脉的起源位于肠系膜上静脉的左侧，位于肠系膜上静脉与脾静脉组成门静脉的联合的远端，位于胰腺的尾端。这

58、种关系的颠倒提示中肠旋转不良。这两个血管之间的关系最好是用横切面图像评价，在胰腺上方扫查并将探头移向尾侧。在确定血管之间关系上频谱多普勒分析是很有用的（图1）。尽管血管倒置是旋转不良的一个标志，但这个标志具有有限的敏感性和特异性。肠系膜血管旋转不良在有中肠旋转不良的儿童中被记录有53%-87%，相反，旋转不良伴有血管倒置的流行其范围在6%-100%不等。超声检查的精确性并不能保证其应用是作为诊断或排除旋转不良的主要研究图像，上胃肠道系统是作为诊断这些异常的研究选择。 HYPERLINK javascript:report_abuse(16627346) 举报 HYPERLINK :/ dxy

59、/bbs/post/view?bid=57&id=16671843 t _blank 【招聘】没找到工作的研究生，本科生必看 mengxuebinglin发贴: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 积分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListVoted 2 状态: 离线 HY

60、PERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 个人资料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 发短消息 2010-02-22 20:54 In volvulus, the midgut rotates around the axis of the superior mesenteric artery. The sonographic finding of volvulus is clockwise twisting