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目的探讨降低超声筛查婴幼儿泌尿系统结石假阳性率和假阴性率的方法。方法利用黑白B超对食用三聚氰胺奶粉的5049例婴幼儿(其中150例已在外院做过B超检查)泌尿系统进行系统扫查,了解有无结石及结石大小、形状、部位,有无肾积水及其他疾病,对初筛阳性或有明显症状而初筛阴性患儿当日由另一专业人员进行彩超复查或CT检查,对比外院初诊结果,分析假阳性和假阴性病例出现的原因。结果5049例患儿中发现泌尿系统结石63例,检出率为1.25%;在本院初筛有结石23例中,经二人二器法检查,6例证实无结石,假阳性率为26.1%;在本院初筛无结石而有明显症状且有奶粉喂养史的48例患儿,经二人二器法,4例证实有结石,假阴性率8.3%。外院诊断为泌尿系统结石在本院复诊的47例患儿中,本院排除结石20例,假阳性率约42.5%;外院诊断为泌尿系结石阴性但有症状来本院复诊的103例中,本院确诊结石15例,假阴性率约14.6%。结论熟练的扫查手法及变换体位多切面探查、合理调节仪器参数、熟练掌握结石诊断新标准、保持膀胱适度充盈和良好的肠道准备、利用彩色血流信号、采取两人两器法等均是超声筛查婴幼儿结石降低假阳性率和假阴性率的方法。
Objective To investigate the methods to reduce the false positive rate and false negative rate of urinary calculi in infants with ultrasound screening. Methods A total of 5049 infants and young children with melamine milk powder (of which 150 had been examined by B-ultrasound in the outpatient department) were systematically scanned with black and white B ultrasound to find out the urinary system size, shape, location, Water and other diseases. On the day of first screening positive or obvious symptoms and screening of negative children, a color Doppler ultrasound examination or CT examination was conducted by another professional on the same day to compare the initial results of the second hospital and analyze the causes of false positive and false negative cases. Results In 5049 cases, urinary system stones were found in 63 cases, with a detection rate of 1.25%. Of the 23 cases initially diagnosed with calculi in our hospital, 2 cases were examined by two-piece method and 6 cases were confirmed as stone-free. The false positive rate was 26.1 %. In our hospital, 48 children who had no history of stone and obvious symptoms and had a history of milk powder feeding were examined by two-person two-piece method. Four cases were confirmed as stone with a false-negative rate of 8.3%. Out of 47 cases diagnosed as urinary system stones in this hospital, 20 cases of stones were excluded and the false-positive rate was about 42.5% in the hospital. Of the 103 patients who were diagnosed as having negative urinary system stones but having symptoms, The hospital diagnosed 15 cases of stone, false negative rate of about 14.6%. Conclusions Skilled scanning technique and multi-slice exploration of position-changing technique are used to reasonably adjust instrument parameters, to master the new standard of stone diagnosis, to maintain proper bladder filling and good bowel preparation, to use color flow signals, Ultrasound screening of infants and young children to reduce the false positive rate and false negative rate of the method.