腹部超聲波

(重定向自腹部超音波

腹部超聲波是一種醫學超聲波檢查,用於檢查人體腹部。在病人腹部塗上超聲波導電凝膠後,超聲波探頭發出的聲波就能穿透腹部表面的腹壁英语Abdominal wall,到達各器官。超聲波探頭將從器官反射的超聲波收集分析後,便能產出腹部影像。因此,這項檢查也被稱為跨腹超聲波,與直接將探頭以內窺鏡方式放入人體中空器官的內鏡超聲波英语Endoscopic ultrasound有所不同。

腹部超聲波檢查
AlokaPhoto2006a.jpg
腹部超聲波檢查所用的超聲波掃描儀
ICD-9-CM88.76
OPS-301英语OPS-3013-059
MedlinePlus003777

腹部超聲波檢查通常由腸胃科内科放射科醫生進行,亦可由超聲波技師英语Sonographer進行。

用途编辑

 
直線型超聲波探頭常用於檢查人體表層的組織。

腹部超聲波可用於判斷不同體內器官的異常,例如腎臟[1]肝臟膽囊胰臟脾臟腹主動脈英语Abdominal aorta等。如果超聲波儀器有多普勒超聲波英语Doppler ultrasonography功能,還可以檢查血管中的血液流動英语Hemodynamics狀況,協助診斷腎動脈狹窄等疾病。此外,腹部超聲波亦常用於檢查懷孕婦女的子宮胎兒;這類檢查稱為產科超音波英语Obstetric ultrasonography[2][3]

當病患出現腹痛急性腹痛英语Acute abdomen,腹部超聲波可用於診斷病者是否患上闌尾炎膽囊炎,以便安排緊急手術[4][5]

當醫生懷疑腹部器官可能異常脹大時,也會進行腹部超聲波檢查。能發現的病症包括腹主動脈瘤脾臟腫大英语Splenomegaly尿瀦留等。診斷為腹主動脈瘤的標準是:腹主動脈(以最外層計算)的直徑超過3厘米,即為腹主動脈瘤[6]

脾臟腫大是傳染性單核白血球增多症的常見症狀。腹部超聲波可以協助檢查患上此症者的狀況[7],但由於正常人體脾臟的大小差異很大,超聲波只應用於協助診斷脾臟腫大,而不應作為診斷的唯一依據,也不應僅依據超聲波結果來決定病者是否適合恢復運動[7]

腹部超聲波也用於檢查腎臟功能英语Assessment of kidney function異常、胰臟消化酶(如澱粉酶胰臟脂酶英语Pancreatic lipase family)功能異常的病人。

 
在腹部超聲波圖像中可以量度腹主動脈的大小。這是協助診斷腹主動脈瘤的重要手段。[6]

結石檢查编辑

超聲波能發現體內的結石,包括腎石膽結石等。由於結石會吸收超聲波,影像上將看到結石的後方出現黑色陰影英语Acoustic shadow[8]

超聲波亦可用於導引不同治療程序,如導引體外震波針刺活檢腹部穿刺引流英语Paracentesis(通過針刺從腹腔中抽走積水的治療)等等[9]

肝臟编辑

 
肝臟超聲波圖像,圖上有數項常用的肝臟大小量度。[10]

腹部超聲波有助診斷肝功能指數異常的原因。超聲波圖像中可以看到的異常包括肝腫大英语hepatomegaly[11]、反射增強(可能由膽汁鬱積英语cholestasis所致)[12]、膽囊或膽管病症、肝臟腫瘤[13]

腎臟超聲波编辑

 
右側腎臟的超聲波影像

腎臟超聲波是診斷與跟進腎臟疾病的重要常用工具。腎臟超聲波的圖像清晰,而且大部分腎臟病變都能在超聲波圖像中識別出來。[14]

技術特點编辑

腹部超聲波的優點包括:方便快捷、可直接在病床邊進行檢查、不需使用對人體(特別是孕婦)有危害的X光、相比其他腹部造影檢查(如電腦掃描)便宜等等[15]。但一個主要缺點則是,如果病人腸道內有大量氣體,或腹部脂肪較多,將難以進行檢查,影像的品質也不好[16]。此外,檢查中能否獲取滿意的超聲波影像,相當依賴進行檢查的醫護人員的經驗與技術水平[17]

腹部超聲波的影像在檢查時就可以即時看到[18],進行檢查時也不須麻醉,所以可以通過移動探頭來檢查病人的反應[19]。例如,將探頭按在病人的膽囊上,如果病人感到痛楚英语Sonographic Murphy sign,即可能是患上急性膽囊炎[20]

超聲波能夠穿透腹壁,檢查骨盆內的器官與組織,例如膀胱卵巢子宫等。水是超聲波極佳的傳導媒介,所以檢查這些器官前,會請病人大量喝水,讓膀胱盡量脹大,以便超聲波訊號穿透[21][22]

參考資料编辑

  1. ^ Bisset. Differential Diagnosis in Abdominal Ultrasound, 3/e. Elsevier India. 2008-01-01: 257 [2011-04-10]. ISBN 978-81-312-1574-6. 
  2. ^ Whitworth, M; Bricker, L; Mullan, C. Ultrasound for fetal assessment in early pregnancy. Cochrane Database of Systematic Reviews. 2015, (7): CD007058. PMC 4084925 . PMID 26171896. doi:10.1002/14651858.CD007058.pub3. 
  3. ^ Salomon, LJ; Alfirevic, Z; Bilardo, CM; Chalouhi, GE; Ghi, T; Kagan, KO; Lau, TK; Papageorghiou, AT; Raine-Fenning, NJ; Stirnemann, J; Suresh, S; Tabor, A; Timor-Tritsch, IE; Toi, A; Yeo, G. ISUOG Practice Guidelines: performance of first-trimester fetal ultrasound scan (PDF). Ultrasound Obstet Gynecol. 2013, 41: 102–113 [2015-05-12]. PMID 23280739. doi:10.1002/uog.12342 . (原始内容 (PDF)存档于2015-09-06). 
  4. ^ Puylaert, Julien B.C.M.; Rutgers, Peter H.; Lalisang, Roy I.; de Vries, Bas C.; van der Werf, Sjoerd D.J.; Dörr, Joep P.J.; Blok, Roeland A.P.R. A Prospective Study of Ultrasonography in the Diagnosis of Appendicitis. New England Journal of Medicine. 1987-09-10, 317 (11): 666–669. ISSN 0028-4793. PMID 3306375. doi:10.1056/NEJM198709103171103. 
  5. ^ Ultrasonography by emergency physicians in patients with suspected cholecystitis. The American Journal of Emergency Medicine. 2001-01-01, 19 (1): 32–36. ISSN 0735-6757. doi:10.1053/ajem.2001.20028 (英语). 
  6. ^ 6.0 6.1 Timothy Jang. Bedside Ultrasonography Evaluation of Abdominal Aortic Aneurysm - Technique. Medscape英语Medscape. 2017-08-28. 
  7. ^ 7.0 7.1 American Medical Society for Sports Medicine, Five Things Physicians and Patients Should Question, Choosing Wisely英语Choosing Wisely: an initiative of the ABIM Foundation英语American Board of Internal Medicine (American Medical Society for Sports Medicine), 24 April 2014 [29 July 2014] , which cites
  8. ^ Dunmire, Barbrina; Harper, Jonathan D.; Cunitz, Bryan W.; Lee, Franklin C.; Hsi, Ryan; Liu, Ziyue; Bailey, Michael R.; Sorensen, Mathew D. Use of the Acoustic Shadow Width to Determine Kidney Stone Size with Ultrasound. Journal of Urology. 2016-01, 195 (1): 171–177 [2021-09-12]. doi:10.1016/j.juro.2015.05.111. 
  9. ^ Dogra, Vikram.; Saad, Wael E. A. Ultrasound-guided procedures. New York, NY: Thieme. 2010. ISBN 9781604061703. 
  10. ^ Christoph F. Dietrich; Carla Serra; Maciej Jedrzejczyk. Ultrasound of the liver - EFSUMB – European Course Book (PDF). European federation of societies for ultrasound in medicine and biology (EFSUMB). 2010-07-28 [2017-12-22]. (原始内容 (PDF)存档于2017-08-12). 
  11. ^ Childs, Jessie T; Esterman, Adrian J; Thoirs, Kerry A; Turner, Richard C. Ultrasound in the assessment of hepatomegaly: A simple technique to determine an enlarged liver using reliable and valid measurements: Ultrasound in the assessment of hepatomegaly. Sonography. 2016-06, 3 (2): 47–52 [2021-09-13]. doi:10.1002/sono.12051. 
  12. ^ Di Serafino, Marco; Gioioso, Matilde; Severino, Rosa; Esposito, Francesco; Vezzali, Norberto; Ferro, Federica; Pelliccia, Piernicola; Caprio, Maria Grazia; Iorio, Raffaele; Vallone, Gianfranco. Ultrasound findings in paediatric cholestasis: how to image the patient and what to look for. Journal of Ultrasound. 2020-03, 23 (1): 1–12 [2021-09-13]. doi:10.1007/s40477-019-00362-9. 
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  14. ^ 內容來自: Hansen, Kristoffer; Nielsen, Michael; Ewertsen, Caroline. Ultrasonography of the Kidney: A Pictorial Review. Diagnostics. 2015, 6 (1): 2. ISSN 2075-4418. PMC 4808817 . PMID 26838799. doi:10.3390/diagnostics6010002.  (CC-BY 4.0)
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