儿科医生对小儿腹痛超声检查的价值

H. Park, J. We, J. Park
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摘要

目的:超声检查(US)作为一种筛查腹痛(AP)的方法被广泛应用。我们调查了一名儿科医生对AP患儿进行US的有效性。方法:回顾性分析2008年12月至2010年7月接受US治疗的AP患儿的医疗记录。结果:共纳入628例患者(男性325例,女性303例)。患者平均年龄为8.08±4.61岁。急性AP病程427例,慢性AP病程201例。AP定位为弥漫性(36.9%)、脐周(24.4%)、上腹部(21.0%)和右下象限(8.1%)。327例(52.1%)患者检查未见异常。超声异常表现为肠系膜淋巴结炎(27.1%)、肠壁增厚(10.0%)、肠套叠(3.0%)、阑尾炎(2.6%)、胆总管囊肿(1.6%)、胰腺炎(0.3%)。我们对39例在美国表现不明确的患者进行了额外的影像学研究,如计算机断层扫描(CT)或磁共振成像(MRI)。在33例(84.6%)患者中,CT或MRI结果相同。经CT检查诊断为阑尾炎2例,胰腺炎1例,紫癜1例。然而,有两例经US诊断的阑尾炎在CT上没有阑尾炎的证据。初始US对儿童腹痛的诊断准确率为99.4%。结论:US作为儿科医生对AP患儿的筛查试验具有快速准确的诊断指征,且具有无创、无辐射的优点。韩国儿科胃肠病学杂志2011;14: 141∼147)
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Usefulness of Ultrasonographic Examination by a Pediatrician in Children with Abdominal Pain
Purpose: Ultrasonography (US) is widely used as a screening test in patients with abdominal pain (AP). We investigated the usefulness of US by a pediatrician in children with AP. Methods: We retrospectively analysed the medical records of children with AP who undertook US from December, 2008 to July, 2010. Results: A total of 628 patients (325 male, 303 female) were enrolled in this study. The mean age of patients was 8.08±4.61 years. Duration of AP was acute in 427 and chronic in 201 patients. Localization of AP was diffuse (36.9%), periumbilical (24.4%), epigastric (21.0%), and right lower quadrant (8.1%). On the examination, there were no abnormal findings in 327 patients (52.1%). Abnormal ultrasonographic findings were mesenteric lymphadenitis (27.1%), intestinal mural thickening (10.0%), intussusception (3.0%), appendicitis (2.6%), choledochal cyst (1.6%), and pancreatitis (0.3%). We performed additional imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) in 39 patients who showed obscure findings on the US. In 33 patients (84.6%), the same results were obtained from CT or MRI. Two cases of appendicitis, one case of pancreatitis and one case of Henoch-Shonlein purpura were diagnosed by the CT examination. However, there were two cases of appendicitis diagnosed by US thathad no evidence of appendicitis on the CT. Diagnostic accuracy of initial US in children with abdominal pain was 99.4%. Conclusion: US by a pediatrician as a screening test in children with AP provides a rapid and accurate diagnostic indication and has non-invasive and radiation-free advantages. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 141∼147)
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