Ma Ya,Wang Zhengrong,Liu Qin,et al.Role of ultrasound in surgical decision making for neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,,21():325-330.[doi:10.3760/cma.j.cn101785-202111057-006]
Role of ultrasound in surgical decision making for neonatal necrotizing enterocolitis
- Keywords:
- Enterocolitis; Necrotizing/DI; Enterocolitis; Necrotizing/SU; Ultrasonography; Infant; Newborn; Case-Control Studies
- Abstract:
- ObjectiveTo explore the clinical value of ultrasonography (US) in surgical decision making in infants with neonatal necrotizing enterocolitis (NEC) by assessing morphological characteristics,vascularity and peristalsis of bowel wall of abdominal US imaging.MethodsFrom September 2017 to March 2020,US findings and other clinical data were retrospectively analyzed for 45 hospitalized NEC children undergoing US examination.They were assigned into non-surgical (n=30) and surgical (n=15) groups.And the inter-group differences of sonographic features were assessed.ResultsAs compared with non-surgical group,surgical group had higher proportions of bowel wall thinning [53.3%(8/15) vs.0%],loss of stratification of bowel wall [100%(15/15) vs.16.7%(5/30)],absence of bowel wall vascularization[73.3%(11/15) vs.0%],absence of peristalsis [93.3%(14/15) vs.33.3%(10/30)] and echogenic free fluid [80%(12/15) vs.0%].The differences were statistically significant (P<0.05).Two groups did not differ significantly in terms of bowel wall thickening [86.7%(13/15) vs.60%(18/30)],pneumatosis intestinalis [73.3%(11/15) vs.70%(21/30)],hypervascularity of affected bowel [20%(3/15) vs.13.3%(4/30)],bowel stenosis [20%(3/15) vs.0%] or portal venous gas [13.3%(2/15) vs.20%(6/30)](P>0.05).Consistency analysis showed echogenic free fluid and absence of bowel wall vascularization on US images had a good agreement with diagnostic abdominal paracentesis for surgical decision making (Kappa value=0.69,P<0.001;Kappa value=0.62,P=0.01).Combinations of two of those parameters indicated that the combination of absence of peristalsis and loss of stratification of bowel wall offered a better profile of sensitivity (93.3%) and specificity (93.3%).ConclusionComprehensive analysis of bowel morphological character,blood perfusion and peristaltic activity on US might help identify the critical status of NEC and provide valuable information on surgical decision making.
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Memo
收稿日期:2021-11-25;改回日期:。
通讯作者:王峥嵘,Email:wzhrong@163.com