目的：旨在通过运用彩色多普勒超声的血流显像技术（CDFI）及脉冲多普勒（PW）频谱分析技术观察先天性肥厚性幽门狭窄（CHPS）患儿的幽门管组织的血流分布、血流速度等情况，以探讨彩色多普勒超声在诊断CHPS并评估其肥厚程度的应用价值。方法：选取2006—2015年广州市第一人民医院新生儿科经超声检查及X线造影检查确诊的65例CHPS患儿，以50例各项生命体征均正常且无临床症状的婴儿作为对照组，对65例CHPS患儿及对照组婴幼儿进行超声检查，记录受检者的幽门形态结构并分别测量幽门肌层厚度、幽门管长径、直径和幽门管内径，通过CDFI检查观察肥厚幽门黏膜各层的彩色血流分布特点并对幽门肌层进行血流分级；通过PW技术进行血流速度测量和频谱分析；另外将CHPS组肌层按厚度分为3组，比较肌层厚度与上述参数间的关系。结果：肥厚的幽门管各层黏膜组织的血流具有分布特征；肌层血流分级为2．83±0．38；最大血流速度（Vmax）为（16.96±0.91） cm/s；阻力指数（RI）为0.68±0．33。65例CHPS患儿的肌层厚度与年龄、体质量、幽门管直径、Vmax、RI均呈正相关（r=0.63、0.48、0.68、0.48、0.42，P均<0.05），与幽门管长度无相关性（r=0.13，P>0.05）。以肌层厚度分为3组的病例中第1组与第2组的血流分级、Vmax及RI无显著差别，血流均较丰富，第3组的血流分级较低，且Vmax加快，RI增大。结论：通过彩色多普勒超声技术检查，可准确掌握幽门管的黏膜各层的血流分布情况和肌层血流分级，并通过测量Vmax及RI以估计幽门狭窄的轻重程度，为临床选择治疗方式乃至为手术治疗方案提供宝贵的客观资料，且简便易行，具有较大的临床应用价值。
Abstract
Objective: This paper aims at using color Doppler flow imaging(CDFI) and pulse wave(PW) spectrum analysis technology to observe the blood flow of canals pyloricus and the blood flow rate and so on in congenital hypertrophic pyloric stenosis(CHPS), objective to investigate the clinical significance and value of Doppler ultrasonography in the diagnosis and assessment of CHPS. Method: The study enrolled 65 cases of CHPS infants and 50 infants without CHPS served as control group. CDFI was done to reveal the distribution feature of blood flow in each layer of the pyloric mucosal canals and the blood flow grade of muscular layer and mucosal layer. PW was done to measure the blood flow rate and frequency analysis. In addition, the muscle layer of CHPS group was divided into 3 groups according to the thickness, and the relationship between the thickness of the muscle layer and the parameters mentioned above was compared. Results: The distribution feature of blood flow in each layer of pyloric canal mucosa was observed clearly by CDFI examination in the CHPS group. The mean grade of flow in the muscular layer was 2.83±0.38. The blood flow maximal velocity(Vmax) of muscular layer was (16.96±0.91) cm/s, and the resistance index(RI) was 0.68±0.33. The thickness of muscle layer in 65 CHPS was positively related to age, weight, diameter of pyloric canal, Vmax and RI, there was no correlation with pyloric tube length. There was no significant difference between the first groups and the second groups in blood flow classification, Vmax and RI, and the blood flow was more abundant. The blood flow of the third groups was lower, and the rate of Vmax and RI increased. Conclusion: CDFI combined with color Doppler artifacts technique is proved to be effective to observe the distribution feature and blood flow grade in each layer of pyloric canal in CHPS patients. Vmax and RI are used to estimate the severity of pyloric stenosis. This method provides the evidence for judging the degree of pyloric stenosis clinically, and furnishes the basis of therapy along with its clinical significance and good application value.
关键词
幽门狭窄 /
肥厚性 /
超声检查 /
多普勒 /
彩色
Key words
Pyloric stenosis, hypertrophic /
Ultrasonography, Doppler, color
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基金
广东省科技计划项目（No.2014A020212014，2014A020212374）。
