CAJ | 학술논문

目的回顾性分析新生儿坏死性小肠结肠炎(NEC)影像学表现与临床的关系,提高对其影像学的认识及诊断水平.方法选取2006年1月1日至2011年12月31日,重庆医科大学附属儿童医院新生儿内、外科收治NEC患儿211例,对其影像学进行总结,分析患儿影像学指标与临床表现及手术的关系.结果 211例中,腹部X线平片无明显变化的40例(19.0％),腹部X线平片动态好转的47例(22.3％),腹部X线平片动态进展恶化的23例(10.9％).腹部X线平片无变化组,预后好与预后差阳性率分别为97.5％、2.5％,腹部X线平片好转组,预后好与预后差阳性率分别为97.9％、2.1％,腹部X线平片恶化组,预后好与预后差阳性率分别是56.5％、43.5％,3组差异有统计学意义(X2 =31.742,P ＜0.01).腹部X线平片和腹部B超诊断气腹的阳性率分别为16.0％(12/75)和1.3％(1/75),(x2=10.191,P＜0.05),对门脉积气的阳性率分别为1.3％ (1/75)、12.0％(9/75),(x2=6.857,P＜0.05).手术时机选择与腹部X线平片显示为气腹(OR=19.543)及肠梗阻(OR=19.527)关系最密切(P＜0.01).结论腹部X线平片是检查NEC的主要方法,腹部X线平片对气腹检测阳性率高,腹部B超对检出门脉积气更敏感,两者互相补充.手术时机选择与腹部X线平片查出气腹或肠梗阻关系最为密切.
목적 회고성분석신생인배사성소장결장염(NEC)영상학표현여림상적관계,제고대기영상학적인식급진단수평.방법 선취2006년1월1일지2011년12월31일,중경의과대학부속인동의원신생인내、외과수치NEC환인211례,대기영상학진행총결,분석환인영상학지표여림상표현급수술적관계.결과 211례중,복부X선평편무명현변화적40례(19.0％),복부X선평편동태호전적47례(22.3％),복부X선평편동태진전악화적23례(10.9％).복부X선평편무변화조,예후호여예후차양성솔분별위97.5％、2.5％,복부X선평편호전조,예후호여예후차양성솔분별위97.9％、2.1％,복부X선평편악화조,예후호여예후차양성솔분별시56.5％、43.5％,3조차이유통계학의의(X2 =31.742,P ＜0.01).복부X선평편화복부B초진단기복적양성솔분별위16.0％(12/75)화1.3％(1/75),(x2=10.191,P＜0.05),대문맥적기적양성솔분별위1.3％ (1/75)、12.0％(9/75),(x2=6.857,P＜0.05).수술시궤선택여복부X선평편현시위기복(OR=19.543)급장경조(OR=19.527)관계최밀절(P＜0.01).결론 복부X선평편시검사NEC적주요방법,복부X선평편대기복검측양성솔고,복부B초대검출문맥적기경민감,량자호상보충.수술시궤선택여복부X선평편사출기복혹장경조관계최위밀절.
Objective To improve the understanding of recognizing and diagnosis of neonatal necrotizing enterocolitis (NEC),imaging assessment of neonates with NEC was analyzed retrospectively.Method Data of 211 cases of NEC were retrospectively collected from the Department of Neonatology,Children's Hospital of Chongqing Medical University between Jan.1st 2006-Dec.31st 2011.Result Analysis of abdominal X-ray of 211cases showed that there were 40 cases (19.0％) who had no changes on each X-ray,47 cases (22.3％) had improvement and 23 cases (10.9％) became worse.In the group of no changes,positive rate with good prognosis was 97.5％ and with poor prognosis,it was 2.5％.In the group of improvement,positive rate with good prognosis was 97.9％,and the contrary was 2.1％.Positive rate with good prognosis was 56.5％,and the contrary was 43.5％ in worse group.Chi-square analysis of the three groups showed x2 =31.742,P ＜ 0.01.Comparison of detection rate of pneumoperitoneum on abdominal X-ray (16.0％,12/75) and Doppler US (1.3％,1/75),x2 =10.191,P ＜0.05,portal pneumatosis on abdominal X-ray(1.3％,1/75) versus Doppler US (12.0％,9/75),x2 =6.857,P ＜ 0.05.Surgical timing mostly corresponded to pneumoperitoneum (OR =19.543) and intestinal obstruction (OR =19.527) of abdominal X-ray.The logistic regression equation is y=-2.915-1.588x1 + 2.972x4 +2.973x7 + 1.711x9 (x2 =101.705,P ＜ 0.01).Conclusion Abdominal X-ray is the most important method of diagnosis of NEC,the group of deterioration of abdominal X-ray has obvious bad prognosis differ from no change group and better group.Comparison with abdominal X-ray and Doppler US,the former in pneumoperitoneum positive rate was higher than the latter,at the same time,portal pneumatosis on Doppler US is more sensitive to abdominal X-ray,the value of two imaging assessments both supplement each other.Surgical timing mostly corresponds to pneumoperitoneum and intestinal obstruction.