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探讨表现为急腹症的Meckel’s憩室病(MD)的超声影像特点及诊断要点,回顾性分析了2009年1月~2012年5月急诊收治的58例经手术病理证实的MD的超声影像特点及其临床资料,并对其漏、误诊情况进行分析。结果提示,58例患者中,术前临床诊断为MD的21例,术中及病理发现MD炎合并急性阑尾炎14例,MD穿孔4例,MD并发肠套叠15例,MD并发肠梗阻14例,MD索带继发肠梗阻、肠坏死5例,无明显并发症MD 5例;急诊超声检查提示MD 8例、MD并发肠套叠1例,提示急性阑尾炎9例、肠套叠12例、肠梗阻12例、肠套叠并发肠梗阻2例,脐膨出、腹腔脓肿各1例。急诊超声提示MD的声像图表现为:脐周或右腹局部形态相对固定的肠管或者厚壁囊性团块,其一端与小肠相通或相连,一端为盲端。分析结果发现,MD超声检出困难(检出率为15.5%),MD的并发症常表现为各种急腹症;急诊超声检查能很好地提示MD的各种并发症如肠套叠、肠梗阻、急性阑尾炎等(其检出率分别为24.1%、24.1%及15.5%),因此对于表现为各种急腹症的MD,超声检查是简便、有效的一线影像手段,扫查时辅以恰当的手法,提高对憩室的发现率,对疾病的诊断和鉴别诊断具有重要意义。
To investigate the ultrasonographic features and diagnosis points of Meckel’s diverticular disease (MD) manifested as acute abdomen, and to review the characteristics of 58 cases of pathologically confirmed MD by emergency department from January 2009 to May 2012 The clinical data, and its leakage, misdiagnosis of the situation for analysis. The results showed that among the 58 patients, 21 cases were diagnosed preoperatively as MD, 14 cases were diagnosed as MD with acute appendicitis by intraoperative and pathological examination, 4 cases were MD perforation, 15 cases were MD complicated with intussusception, 14 cases were MD complicated with intestinal obstruction , MD cord with secondary intestinal obstruction, intestinal necrosis in 5 cases, no obvious complications in MD 5 cases; emergency ultrasound examination showed 8 cases of MD, MD complicated with intussusception in 1 case, suggesting that 9 cases of acute appendicitis, intussusception in 12 cases, Intestinal obstruction in 12 cases, intussusception complicated by intestinal obstruction in 2 cases, umbilical swelling, abdominal abscess in 1 case. Emergency ultrasound prompts the MD of the sonogram showed: the umbilical or right abdominal local morphology of the relatively fixed bowel or thick cystic mass, one end connected to the small intestine or connected to one end of the blind end. The results showed that MD was difficult to detect (the detection rate was 15.5%). The complication of MD often showed various kinds of acute abdomen. The emergency ultrasonography could prompt various complications of MD such as intussusception, Intestinal obstruction, acute appendicitis, etc. (the detection rates were 24.1%, 24.1% and 15.5%, respectively). Therefore, ultrasonography is a simple and effective first-line imaging method for MD with various acute abdomen diseases. Appropriate measures to improve the detection rate of diverticulum, the diagnosis and differential diagnosis of disease is of great significance.