Ling U P, Chen J Y, Hwang C J, Lin C K, Chang M H
Department of Paediatrics, Chung Shan, Taichung, Taiwan, Republic of China.
Arch Dis Child. 1995 Jul;73(1):70-3. doi: 10.1136/adc.73.1.70.
Prewarmed saline enemas and transabdominal ultrasound (hydrosonography) were used to evaluate 17 consecutive children with rectal bleeding before colonoscopy. Twelve patients with polyps were identified (10 by ultrasound, 10 by endoscopy): these included multiple hyperplastic polyps (1), multiple polyps (1), solitary polyps (9), and pseudopolyps (1). Ultrasound identified 11 polyps in 10 patients, missing two patients with small polyps less than 0.5 cm in diameter. The polyps were hyperechoic ovoid masses fixed to the colonic wall, with a stalk (7), submucosal infolding (5), and intraluminal floating (5). There was one false positive. Colonoscopy was refused by one patient and failed to reach beyond the distal sigmoid in another following previous surgery for malrotation. Colonoscopy was superior in identifying finer mucosal detail (colitis, ulcers, proctitis, anal fissure) and in detecting smaller polyps (sessile polyps, hyperplastic polyps). Hydrosonography of the colon is a simple, relatively non-invasive procedure that provides an alternative, radiation-free examination of the whole colon before colonoscopy. It is complementary to colonoscopy in the management of rectal bleeding in children.
在结肠镜检查前，采用预热的生理盐水灌肠和经腹超声检查（水超声检查）对17例连续性直肠出血患儿进行评估。共识别出12例息肉患者（超声检查发现10例，内镜检查发现10例）：其中包括多发性增生性息肉（1例）、多发性息肉（1例）、孤立性息肉（9例）和假息肉（1例）。超声检查在10例患者中发现了11个息肉，漏诊了2例直径小于0.5 cm的小息肉。息肉为固定于结肠壁的高回声卵圆形肿块，有蒂（7例）、黏膜下皱襞（5例）和腔内漂浮（5例）。有1例假阳性。1例患者拒绝接受结肠镜检查，另1例患者因既往旋转不良手术史，结肠镜未能到达乙状结肠远端。结肠镜检查在识别更细微的黏膜细节（结肠炎、溃疡、直肠炎、肛裂）和检测较小息肉（无蒂息肉、增生性息肉）方面更具优势。结肠水超声检查是一种简单、相对无创的检查方法，可在结肠镜检查前对整个结肠进行无辐射的替代检查。在儿童直肠出血的处理中，它与结肠镜检查互为补充。
