Gimondo P, La Bella A
Servizio di Diagnostica per Immagini, Ospedale "S. Sebastiano M.", USL RM/29 Frascati, Roma.
Radiol Med. 1995 Mar;89(3):264-9.
Intestinal motility is currently evaluated by means of clinical, radiologic and electromanometric methods. Of late, US has allowed to visualize the intestinal loops and their movements directly assessing wall patterns and endoluminal contents, as well as the degree of distension of the ileal loops; its diagnostic value is in fact well established in the study of such specific diseases of the GI tract as inflammatory conditions and neoplasms. On the contrary, the use of duplex-Doppler US to investigate bowel motility is quite new. We used duplex-Doppler US to evaluate intestinal peristalsis in 37 patients presenting with acute abdominal pain (15 patients with early mechanical obstruction; 13 patients with long-standing mechanical obstruction; 9 patients with paralytic ileus). In 29 patients the diagnosis was surgically confirmed; in 8 patients the diagnosis was established by means of other diagnostic techniques. The duplex-Doppler recordings showed typical patterns characterized by different degrees of signal intensity and frequency according to the type of obstruction (mechanical or paralytic ileus), to its duration (acute or long-standing), and to the site of Doppler sampling (proximal to or in the obstacle). As regards the correct identification of the cause of the obstruction, duplex-Doppler sensitivity and specificity were 85% and 100%, respectively. The positive predictive value was high (100%) whereas the negative predictive value was low (37.5%). Duplex-Doppler evaluation provides both qualitative and quantitative data about intestinal peristalsis, allowing true peristaltic movements to be discriminated from simple mixing movements of the bowel. The possibility to identify intestinal segments with different degrees of peristaltic activity seems very useful to detect the site of the obstacle in mechanical obstruction.
目前，肠道动力通过临床、放射学和测压法进行评估。近来，超声已能够直接观察肠袢及其运动，评估肠壁形态、腔内内容物以及回肠袢的扩张程度；其诊断价值在诸如炎症性疾病和肿瘤等胃肠道特定疾病的研究中已得到充分确立。相反，使用双功多普勒超声研究肠道动力则相当新颖。我们使用双功多普勒超声对37例急性腹痛患者的肠道蠕动进行评估（15例早期机械性肠梗阻患者；13例长期机械性肠梗阻患者；9例麻痹性肠梗阻患者）。29例患者的诊断经手术证实；8例患者的诊断通过其他诊断技术确立。双功多普勒记录显示出典型模式，根据梗阻类型（机械性或麻痹性肠梗阻）、梗阻持续时间（急性或长期）以及多普勒取样部位（梗阻近端或梗阻处），信号强度和频率各不相同。关于梗阻原因的正确识别，双功多普勒的敏感性和特异性分别为85%和100%。阳性预测值较高（100%），而阴性预测值较低（37.5%）。双功多普勒评估提供了关于肠道蠕动的定性和定量数据，能够将真正的蠕动运动与肠道的简单混合运动区分开来。识别具有不同程度蠕动活动的肠段的可能性对于检测机械性肠梗阻的梗阻部位似乎非常有用。
