航空航天医学杂志

目的 探讨B超与上消化道造影在新生儿呕吐性疾病中的诊断价值及临床应用策略。方法 回顾性分析2021年01月至2024年12月开封市儿童医院收治的77例呕吐新生儿临床资料，其中，外科性疾病39例、内科性疾病38例，所有患儿均接受超声和(或)上消化道造影检查。计算两种检查方法灵敏度、特异度及与临床诊断结果的一致性。结果 39例外科性疾病中，幽门狭窄7例，肠旋转不良9例，胃扭转12例，其他11例。B超诊断新生儿呕吐为外科性疾病的灵敏度为56.41%,特异度为84.21%,与临床诊断的一致性中等(Kappa=0.405,P=0.000);上消化道造影诊断外科性疾病的灵敏度为56.41%,特异度为94.74%,与临床诊断的一致性中等(Kappa=0.509,P=0.000)。B超诊断外科疾病患儿为幽门狭窄的灵敏度为100.00%,特异度96.88%,与临床诊断的一致性极好(Kappa=0.918,P=0.000);上消化道造影诊断幽门狭窄的灵敏度为14.29%,特异度为96.88%,与临床诊断的一致性极低(Kappa=0.155,P=0.225)。B超诊断外科性疾病为肠旋转不良的灵敏度为77.78%,特异度为93.33%,与临床诊断的一致性较好(Kappa=0.711,P=0.000);上消化道造影诊断肠旋转不良的灵敏度55.56%,特异度为96.67%,与临床诊断的一致性中等(Kappa=0.591,P=0.000)。结论 B超与上消化道造影在新生儿呕吐性疾病中均具有较高的特异度，其中B超诊断幽门狭窄与临床一致性极好。临床可优先采取B超检查，如有必要再行上消化道造影，以及时确诊。

Objective To explore the diagnostic value and clinical application strategies of B-ultrasound and upper gastrointestinal series in neonatal vomiting disorders. Methods The clinical data of 77 neonates with vomiting admitted to Kaifeng Children from January 2021 to December 2024 were retrospectively analyzed, of whom 39 had surgical conditions and 38 had medical conditions. All neonates underwent B-ultrasound and/or upper gastrointestinal series examinations. The sensitivity, specificity, and agreement with the final clinical diagnosis were calculated for both imaging modalities. Results Among the 39 surgical cases, there were 7 cases of pyloric stenosis, 9 of intestinal malrotation, 12 of gastric volvulus, and 11 others. For diagnosing surgical conditions, B-ultrasound demonstrated a sensitivity of 56.41% and a specificity of 84.21%, with moderate agreement with the clinical diagnosis(Kappa=0.405, P=0.000); upper gastrointestinal series demonstrated a sensitivity of 56.41% and a specificity of 94.74%, with moderate agreement with the clinical diagnosis(Kappa=0.509, P=0.000). In diagnosing pyloric stenosis among the surgical cases, B-ultrasound demonstrated a sensitivity of 100.00% and a specificity of 96.88%, with almost perfect agreement with the clinical diagnosis(Kappa=0.918, P=0.000); upper gastrointestinal series demonstrated a sensitivity of 14.29% and a specificity of 96.88%, with slight agreement(Kappa=0.155, P=0.225). For intestinal malrotation, B-ultrasound demonstrated a sensitivity of 77.78% and a specificity of 93.33%, with substantial agreement(Kappa=0.711, P=0.000); upper gastrointestinal series demonstrated a sensitivity of 55.56% and a specificity of 96.67%, with moderate agreement(Kappa=0.591, P=0.000). Conclusions Both B-ultrasound and upper gastrointestinal series exhibit high specificity in the evaluation of neonatal vomiting. Notably, B-ultrasound shows almost perfect agreement with the clinical diagnosis for pyloric stenosis. Therefore, B-ultrasound is recommended as the preferred initial imaging modality, with upper gastrointestinal series reserved for further evaluation when indicated, to facilitate prompt and accurate diagnosis.