兒童急腹癥的超聲檢查

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. 兒童急腹癥的超聲檢查關(guān)鍵詞 青少年 闌尾炎 旋轉(zhuǎn)不良 超聲隨著分級(jí)加壓超聲檢查技術(shù)的介紹及超聲技術(shù)的不斷前進(jìn)，超聲在評(píng)價(jià)可疑有急腹癥的兒

4、童中的作用已逐步增加。超聲的首要角色是表示出那些與急腹癥狀及征象有關(guān)的情況的本質(zhì)特征，并且區(qū)分出哪些需要外科手術(shù)及哪些不需要外科手術(shù)。本文對(duì)兒童腹部普通的而又重要的具有外科條件的超聲評(píng)價(jià)進(jìn)行了綜述。超聲應(yīng)用的指征，普通病變的超聲特征及用于診斷的最佳超聲技術(shù)均在本文提及。 如果你贊同本文的內(nèi)容, 可以給作者, 你在連續(xù)七天內(nèi)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) 舉報(bào) HYPERLINK :/ dxy /bbs/post/vie

5、w?bid=113&id=16696774 t _blank 【討論】淺談老年人的眼部整形及其它（雜談） mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/

6、 dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)短消息 2010-02-21 21:13 初次翻譯，不當(dāng)處請(qǐng)朋友多多指教，謝謝！ HYPERLINK javascript:report_abuse(16621735) 舉報(bào) HYPERLINK :/ dxy /bbs/post/view?bid=144&id=16693752 t _blank 【原創(chuàng)】充分認(rèn)識(shí)手術(shù)安全現(xiàn)狀 加強(qiáng)手術(shù)安全管理 mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?user

7、name=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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.超聲技術(shù)掌握病人的癥狀，體格檢查及實(shí)驗(yàn)室數(shù)據(jù)是很重要的，可以集中在檢查點(diǎn)并提高正確檢查的可能性。如果疼痛位于右上腹部，超聲圖像應(yīng)集中看肝，膽囊，膽管，胰腺和右腎。如果疼痛位于右下腹部，盲腸，小腸和骨盆器官應(yīng)該詳細(xì)檢查。這些區(qū)分多少有點(diǎn)是人工假設(shè)的，但能夠在檢查兒童急腹癥疼痛中充當(dāng)一個(gè)準(zhǔn)則。如果疼痛位于其他位置，檢查也

11、要相應(yīng)的置于這些特定區(qū)域。 /bbs/actions/rate_post?id=16621754&bid=197&action=ListAll t _blank 查看所有投票本貼已得 1 同行票!mengxuebinglin edited on 2010-02-21 21:30 HYPERLINK javascript:report_abuse(16621754) 舉報(bào) t _blank 【討論】協(xié)和出版社李春宇副社長(zhǎng)答疑：協(xié)和2010醫(yī)師資格考試用書(shū)有哪些優(yōu)勢(shì)？ mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=meng

12、xuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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.分級(jí)加壓超聲檢查法分級(jí)加壓檢查技術(shù)被用來(lái)評(píng)價(jià)可疑闌尾炎，急性腸道疾病及腸系膜淋巴結(jié)炎。線陣的或扇形的探頭用來(lái)逐步加壓右下腹部。輕輕的逐步的壓力作用于前腹壁可導(dǎo)致正常腸袢的位置移動(dòng)和受壓。檢查開(kāi)始，要讓病人用單個(gè)手指指出壓痛或疼痛最大的點(diǎn)。這種定位可以加速派遣向闌尾炎癥的掃查，尤其是位置異常的闌尾，可以縮短檢查時(shí)間。 mengxuebinglin edited on 2010-02-21 21:31 HYPERLINK javascript:report_abuse(16621821) 舉

16、報(bào) ?bid=119&id=14039074 t _blank 【眼整形討論】少見(jiàn)的眼面部血管瘤 mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy

17、 /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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.掃查以鑒定升結(jié)腸的切面開(kāi)始，升結(jié)腸是以包含有氣體及液體的不蠕動(dòng)的結(jié)構(gòu)出現(xiàn)。然后探頭向下移向盲腸尖端，這里可能有闌尾出現(xiàn)。逐步向盲腸尖端加壓，可以將來(lái)自盲腸的氣體和糞便類(lèi)物質(zhì)趕走并加強(qiáng)闌尾和遠(yuǎn)端小腸的顯示效果。正常的回腸末端是容易壓縮的并能夠展示活躍的蠕動(dòng)。腰肌

20、和髂外血管應(yīng)該能夠鑒別出，因?yàn)殛@尾就位于這些結(jié)構(gòu)的前面。要獲取灰階及彩色多普勒?qǐng)D像。 mengxuebinglin edited on 2010-02-21 21:32 HYPERLINK javascript:report_abuse(16621844) 舉報(bào) s/post/view?bid=50&id=16690201 t _blank 頸椎病，先天性阻滯椎請(qǐng)教手術(shù)方案 mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ d

21、xy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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骨盆的超聲檢查兒童骨盆病理學(xué)的超聲評(píng)估是利用膨脹的膀胱作為透聲

25、窗進(jìn)行經(jīng)腹檢查來(lái)完成的。膨脹的膀胱可以趕走位于盆腔的充滿氣體的腸道，從而使得超聲可以透射盆腔更深的結(jié)構(gòu)同時(shí)使卵巢和子宮更易顯示。大部分兒童的膀胱適度充盈通過(guò)口服液體即可完成。如果患兒不能忍受口服大量液體，可以通過(guò)膀胱導(dǎo)尿術(shù)灌注消毒的液體。在有些情況下，讓病人臥位并且直接掃查附件位置可以提高卵巢的顯示效果。骨盆的超聲檢查是用扇形或彎曲排列的探頭完成的。骨盆器官的掃查可以通過(guò)縱切及橫切面獲得。要獲取灰階及彩色多普勒?qǐng)D像。 HYPERLINK javascript:report_abuse(16621896) 舉報(bào) 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醫(yī)院誠(chéng)聘各醫(yī)學(xué)專業(yè)人才bitter發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=bitter&action=Search 670 積分: HYPERLINK :/ dxy /bbs/user/info?uid=306194&action=ListScored 27 得票: HYPERLINK :/ dxy /bbs/user/info?uid=306194&action=ListVoted 5 狀態(tài): 隱身 HYPERLINK :/ dxy /bb

27、s/user/info?uid=306194 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=bitter t _blank 發(fā)短消息 2010-02-22 15:12 期待，請(qǐng)繼續(xù)！ HYPERLINK javascript:report_abuse(16625350) 舉報(bào) HYPERLINK :/ dxy /bbs/post/view?bid=53&id=16692639 t _blank 【動(dòng)態(tài)】總理報(bào)告：積極穩(wěn)妥推進(jìn)醫(yī)藥衛(wèi)生體制改革 mengxuebinglin發(fā)貼: HYPERLINK

28、:/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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對(duì)于用過(guò)填塞物或性生活活躍的青春期

31、女性，陰道超聲檢查可以作為一個(gè)替代技術(shù)。陰道超聲優(yōu)于經(jīng)腹超聲的一個(gè)主要優(yōu)點(diǎn)是避免充盈膀胱。這個(gè)技術(shù)的主要局限性是觀察視野的受限。由于這個(gè)問(wèn)題，經(jīng)腹超聲檢查被用作檢查以前沒(méi)有做過(guò)骨盆超聲檢查的病人的首要方法。如果經(jīng)腹的檢查所見(jiàn)是不定的，困惑的或者要更好地表現(xiàn)卵巢和輸卵管的病狀可以應(yīng)用經(jīng)陰道超聲來(lái)進(jìn)行研究。 mengxuebinglin edited on 2010-02-22 20:27 HYPERLINK javascript:report_abuse(16627027) 舉報(bào) HYPERLINK :/ dxy /bbs/post/view?bid=197&id=16668842 t _bla

32、nk 【請(qǐng)教】右下腹包塊？ mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMess

33、age&to=mengxuebinglin t _blank 發(fā)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.陰囊的超聲檢查陰囊的超聲檢查是在病人仰臥位的條件下進(jìn)行，同時(shí)陰囊要輕輕鼓起并用毛巾放在大腿之間起支持作用。要用高頻的線陣探頭以使陰囊內(nèi)容物的分辨率達(dá)到最大。陰囊及內(nèi)容物要橫切與縱切并用。半睪丸膜也應(yīng)檢查，以區(qū)分出陰囊內(nèi)容物的大小及回聲的不同。要獲取灰階，彩色及脈沖多普勒?qǐng)D像。 mengxuebinglin edited on 2010-02-22 20:28 HYPERLINK javascript:report_abuse(16627049) 舉報(bào) HYPERLINK :/ dxy /bbs/post/view?bid=12&id=16615908 t _blank 【討論】20

36、10報(bào)考第四軍醫(yī)大學(xué)的同學(xué)們曬曬成績(jī)吧 mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=Wri

37、teMessage&to=mengxuebinglin t _blank 發(fā)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.腹部的外科情況在兒童中最盛行的要求急性外科手術(shù)的疾病是急性闌尾炎和幽門(mén)狹窄。其他的情況包括旋轉(zhuǎn)不良，消化問(wèn)題，急性卵巢和陰囊的疾病。根據(jù)病人的年齡，疼痛的類(lèi)型及定位，其他癥狀和體征的出現(xiàn)和消失以及病人的實(shí)驗(yàn)室數(shù)據(jù)可縮小鑒別診斷的范圍。只要這些因素都考慮了，做出一個(gè)特異性的診斷并不是不可能的，研究圖像，比如超聲，對(duì)于做出正確的診斷及迅速的治療也是必需的。 HYPERLINK javascri

40、pt:report_abuse(16627094) 舉報(bào) HYPERLINK :/ dxy /bbs/post/view?bid=12&id=16615908 t _blank 【討論】2010報(bào)考第四軍醫(yī)大學(xué)的同學(xué)們曬曬成績(jī)吧 mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLIN

41、K :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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.旋轉(zhuǎn)不良是嬰兒的一個(gè)急癥，尤其是伴有中腸旋轉(zhuǎn)不良。在胚胎發(fā)育過(guò)程中，十二指腸空腸連接和盲腸

45、要經(jīng)歷270度的旋轉(zhuǎn)，導(dǎo)致兩者在腹膜后固定，其中十二指腸空腸連接位于左上象限Treitz 懸韌帶位置，盲腸位于右下象限。在旋轉(zhuǎn)過(guò)程中，小腸是被寬大的腸系膜懸吊著，腸系膜可以在 Treitz 懸韌帶和回盲瓣之間延伸。旋轉(zhuǎn)不良一詞涉及一系列旋轉(zhuǎn)不良的異常情況，包括旋轉(zhuǎn)失?。ńY(jié)腸位于左側(cè)，小腸位于右側(cè)），不轉(zhuǎn)位但反位（小腸位于左側(cè)，結(jié)腸位于右側(cè)），以及旋轉(zhuǎn)不全（不轉(zhuǎn)位和正常旋轉(zhuǎn)之間的一系列異常）。在旋轉(zhuǎn)不良中，腸的附著異常的短，導(dǎo)致腸系膜蒂狹窄及Treitz懸韌帶的異位。 HYPERLINK javascript:report_abuse(16627231) 舉報(bào) HYPERLINK :/ dxy

46、/bbs/post/view?bid=57&id=16672552 t _blank 【招聘】山東大學(xué)齊魯醫(yī)院關(guān)于2010年畢業(yè)生招聘及人才引進(jìn)的通知 mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _

47、blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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.有旋轉(zhuǎn)不良的病人會(huì)有頻率極高的十二指腸梗阻，這是由腹壁外的十二指腸旁索帶壓迫十二指腸，中腸旋轉(zhuǎn)不良或者這些異常問(wèn)題的聯(lián)合導(dǎo)致的。十二指腸旁索帶代表著在不全旋轉(zhuǎn)的腸的固定中的一種嘗試，這些索帶能夠妨礙十二指腸的第二和第三部分在通過(guò)異位的盲腸時(shí)到達(dá)后腹膜或側(cè)腹壁。中腸旋轉(zhuǎn)不良的更嚴(yán)重的并發(fā)癥是腸扭轉(zhuǎn)，腸扭轉(zhuǎn)能夠使病人腸缺血和壞死。大約80%到90%有旋轉(zhuǎn)不良的病人在生后一月內(nèi)伴有嘔吐，

51、嘔吐物幾乎全是膽汁。大一點(diǎn)的孩子可以伴有由腸系膜淋巴管淤滯或周期性的腹痛和片段的腸扭轉(zhuǎn)所致的嘔吐所導(dǎo)致的吸收不良綜合征。 HYPERLINK javascript:report_abuse(16627289) 舉報(bào) HYPERLINK :/ dxy /bbs/post/view?bid=57&id=16666998 t _blank 【政策】2010年3月1日上海官方細(xì)則 mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dx

52、y /bbs/user/info?uid=1471676&action=ListScored 5 得票: ed 2 狀態(tài): 離線 HYPERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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.對(duì)于評(píng)估有膽汁性嘔吐和可疑旋轉(zhuǎn)不良的嬰兒來(lái)說(shuō)上胃腸道的檢查是首要的圖像研究法。如果具有膽汁顏色的嘔吐物的重要性不被重視，超聲顯像應(yīng)該是首要檢查，同時(shí)放射科醫(yī)生應(yīng)該熟悉旋轉(zhuǎn)不良的超聲檢查所見(jiàn)。通常腸系膜上動(dòng)脈的起源位于腸系膜上靜脈的左側(cè)，位于腸系膜上靜脈與脾靜脈組成門(mén)靜脈的聯(lián)合的遠(yuǎn)端，位于胰腺的尾端。這

58、種關(guān)系的顛倒提示中腸旋轉(zhuǎn)不良。這兩個(gè)血管之間的關(guān)系最好是用橫切面圖像評(píng)價(jià)，在胰腺上方掃查并將探頭移向尾側(cè)。在確定血管之間關(guān)系上頻譜多普勒分析是很有用的（圖1）。盡管血管倒置是旋轉(zhuǎn)不良的一個(gè)標(biāo)志，但這個(gè)標(biāo)志具有有限的敏感性和特異性。腸系膜血管旋轉(zhuǎn)不良在有中腸旋轉(zhuǎn)不良的兒童中被記錄有53%-87%，相反，旋轉(zhuǎn)不良伴有血管倒置的流行其范圍在6%-100%不等。超聲檢查的精確性并不能保證其應(yīng)用是作為診斷或排除旋轉(zhuǎn)不良的主要研究圖像，上胃腸道系統(tǒng)是作為診斷這些異常的研究選擇。 HYPERLINK javascript:report_abuse(16627346) 舉報(bào) HYPERLINK :/ dxy

59、/bbs/post/view?bid=57&id=16671843 t _blank 【招聘】沒(méi)找到工作的研究生，本科生必看 mengxuebinglin發(fā)貼: HYPERLINK :/ dxy /bbs/post/search?username=mengxuebinglin&action=Search 98 積分: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListScored 5 得票: HYPERLINK :/ dxy /bbs/user/info?uid=1471676&action=ListVoted 2 狀態(tài): 離線 HY

60、PERLINK :/ dxy /bbs/user/info?uid=1471676 t _blank 個(gè)人資料 HYPERLINK :/ dxy /bbs/user/message?action=WriteMessage&to=mengxuebinglin t _blank 發(fā)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