高频超声对新生儿坏死性小肠结肠炎需手术治疗的预测价值
The value of high-frequency ultrasonography in diagnosing the surgical treatment of neonatal necrotizing enterocolitis
杨薇 1裴广华 1徐魏军 1赵绪稳2
作者信息
- 1. 天津市儿童医院(天津大学儿童医院)超声科,天津 300074
- 2. 天津市儿童医院(天津大学儿童医院)新生儿外科,天津 300074
- 折叠
摘要
目的 探讨高频超声对新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)需手术治疗的预测价值.方法 选择2018年1月至2021年12月天津市儿童医院新生儿外科诊断为Bell分期Ⅱ期以上的NEC患儿进行回顾性分析.根据是否手术分为手术组和非手术组,比较两组超声检查肠蠕动、肠壁血流灌注、肠壁积气、门静脉积气、腹腔积液内透声、腹腔积液深度、肠壁厚度情况,采用logistic回归分析NEC患儿需手术干预的危险因素,并做受试者工作特征曲线分析,计算联合因子和单一因子预测NEC患儿急性期需手术治疗的价值.结果 共纳入40例,手术组18例,非手术组22例.两组超声检查肠壁积气、腹腔积液深度差异无统计学意义(P＞0.05);手术组肠蠕动减弱、门静脉积气、肠壁血流灌注减少、腹腔积液透声差比例均高于非手术组,肠壁厚度小于非手术组(P＜0.05).Logistic回归分析显示,腹腔积液透声差、肠壁变薄、肠壁血流灌注减少及肠蠕动减弱对NEC患儿需手术治疗有较高的预测效能.受试者工作特征曲线分析显示预测NEC患儿需手术治疗的肠壁厚度临界值为1.2 mm,曲线下面积0.746,敏感度87.5％,特异度65.6％;联合因子预测NEC患儿需手术干预的曲线下面积为0.867,敏感度96.9％,特异度75.8％.结论 高频超声显示肠蠕动减弱、肠壁血流灌注减少、肠壁变薄及腹腔积液内透声差对NEC急性期是否需手术治疗有较高的预测效能.
Abstract
Objective To determine the predictive value of high-frequency ultrasonography for necrotizing enterocolitis(NEC)requiring surgical treatment in neonates.Methods From January 2018 to December 2021,neonates diagnosed with NEC(Bell stage Ⅱ and above)in our hospital were retrospectively analyzed.The neonates were assigned into surgical group and non-surgical group according to the treatment.The following ultrasonography results were compared between the two groups:intestinal motility,gastrointestinal(GI)wall perfusion,pneumatosis intestinalis(PI),portal vein gas,peritoneal effusion translucency,depth of ascites fluid and GI wall thickness.Logistic regression was used to determine risk factors of surgical treatment for NEC.ROC curve was drawn to calculate the predictive value of combined and individual factors for NEC requiring surgical treatment.Results A total of 40 neonates were enrolled,including 18 in the surgical group and 22 in the non-surgical group.No significant differences existed between the two groups in PI and depth of ascites fluid(P＞0.05).The surgical group had higher incidences of decreased intestinal motility,portal vein gas,reduced GI wall perfusion,poor peritoneal effusion translucency and thinner GI wall than the non-surgical group(all P＜0.05).Logistic regression analysis showed that poor translucency of peritoneal effusion,thinning of GI wall,reduced GI wall perfusion and decreased intestinal motility were risk factors for surgical treatment of NEC.ROC curve showed that the cut-off value predicting surgical treatment based on GI wall thickness was 1.2 mm,with an area under the curve(AUC)of 0.746,sensitivity of 87.5％and specificity of 65.6％.The AUC of the combined factors predicting surgical treatment was 0.867,with sensitivity of 96.9％and specificity of 75.8％.Conclusions Decreased intestinal motility and GI wall perfusion,thinning of GI wall and poor peritoneal effusion translucency on high-frequency ultrasonography have high predictive efficacy for the need of surgical treatment in the acute phase of NEC.
关键词
新生儿/坏死性小肠结肠炎/超声/肠壁积气/门静脉积气Key words
Newborn/Necrotizing enterocolitis/Ultrasonography/Gas in the bowel wall/Portal gas引用本文复制引用
出版年
2024
NETL
NSTL
维普
万方数据