腹部超声波是一种医学超声波检查,用于检查人体腹部。在病人腹部涂上超声波导电凝胶后,超声波探头发出的声波就能穿透腹部表面的腹壁英语Abdominal wall,到达各器官。超声波探头将从器官反射的超声波收集分析后,便能产出腹部影像。因此,这项检查也被称为跨腹超声波,与直接将探头以内窥镜方式放入人体中空器官的内镜超声波英语Endoscopic ultrasound有所不同。

腹部超声波检查
腹部超声波检查所用的超声波扫描仪
ICD-9-CM88.76
OPS-301英语OPS-3013-059
MedlinePlus003777

腹部超声波检查通常由肠胃科内科放射科医生进行,亦可由超声波技师英语Sonographer进行。

用途

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直线型超声波探头常用于检查人体表层的组织。

腹部超声波可用于判断不同体内器官的异常,例如肾脏[1]肝脏胆囊胰脏脾脏腹主动脉英语Abdominal aorta等。如果超声波仪器有多普勒超声波英语Doppler ultrasonography功能,还可以检查血管中的血液流动状况,协助诊断肾动脉狭窄等疾病。此外,腹部超声波亦常用于检查怀孕妇女的子宫胎儿;这类检查称为产科超声波英语Obstetric ultrasonography[2][3]

当病患出现腹痛急性腹痛英语Acute abdomen,腹部超声波可用于诊断病者是否患上阑尾炎胆囊炎,以便安排紧急手术[4][5]

当医生怀疑腹部器官可能异常胀大时,也会进行腹部超声波检查。能发现的病症包括腹主动脉瘤脾脏肿大英语Splenomegaly尿潴留等。诊断为腹主动脉瘤的标准是:腹主动脉(以最外层计算)的直径超过3厘米,即为腹主动脉瘤[6]

脾脏肿大是传染性单核白血球增多症的常见症状。腹部超声波可以协助检查患上此症者的状况[7],但由于正常人体脾脏的大小差异很大,超声波只应用于协助诊断脾脏肿大,而不应作为诊断的唯一依据,也不应仅依据超声波结果来决定病者是否适合恢复运动[7]

腹部超声波也用于检查肾脏功能英语Assessment of kidney function异常、胰脏消化酶(如淀粉酶胰脏脂酶英语Pancreatic lipase family)功能异常的病人。

 
在腹部超声波图像中可以量度腹主动脉的大小。这是协助诊断腹主动脉瘤的重要手段。[6]

结石检查

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超声波能发现体内的结石,包括肾石胆结石等。由于结石会吸收超声波,影像上将看到结石的后方出现黑色阴影英语Acoustic shadow[8]

超声波亦可用于导引不同治疗程序,如导引体外震波针刺活检腹部穿刺引流英语Paracentesis(通过针刺从腹腔中抽走积水的治疗)等等[9]

肝脏

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肝脏超声波图像,图上有数项常用的肝脏大小量度。[10]

腹部超声波有助诊断肝功能指数异常的原因。超声波图像中可以看到的异常包括肝肿大[11]、反射增强(可能由胆汁郁积英语cholestasis所致)[12]、胆囊或胆管病症、肝脏肿瘤[13]

肾脏超声波

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右侧肾脏的超声波影像

肾脏超声波是诊断与跟进肾脏疾病的重要常用工具。肾脏超声波的图像清晰,而且大部分肾脏病变都能在超声波图像中识别出来。[14]

技术特点

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腹部超声波的优点包括:方便快捷、可直接在病床边进行检查、不需使用对人体(特别是孕妇)有危害的X光、相比其他腹部造影检查(如电脑扫描)便宜等等[15]。但一个主要缺点则是,如果病人肠道内有大量气体,或腹部脂肪较多,将难以进行检查,影像的品质也不好[16]。此外,检查中能否获取满意的超声波影像,相当依赖进行检查的医护人员的经验与技术水平[17]

腹部超声波的影像在检查时就可以即时看到[18],进行检查时也不须麻醉,所以可以通过移动探头来检查病人的反应[19]。例如,将探头按在病人的胆囊上,如果病人感到痛楚英语Sonographic Murphy sign,即可能是患上急性胆囊炎[20]

超声波能够穿透腹壁,检查骨盆内的器官与组织,例如膀胱卵巢子宫等。水是超声波极佳的传导媒介,所以检查这些器官前,会请病人大量喝水,让膀胱尽量胀大,以便超声波讯号穿透[21][22]

参考资料

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  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 [2021-09-13]. ISSN 0735-6757. doi:10.1053/ajem.2001.20028. (原始内容存档于2021-09-13) (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], (原始内容存档于2014-07-29) , 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. (原始内容存档于2021-09-13). 
  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. (原始内容存档于2022-03-14). 
  13. ^ Janice Hickey, Franklin Goldberg. Ultrasound review of the abdomen, male pelvis & small parts. Philadelphia : Lippincott. 1999. ISBN 0397516916. 
  14. ^ 内容来自: 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)页面存档备份,存于互联网档案馆
  15. ^ Noone, Tara C.; Semelka, Richard C.; Chaney, Deneise M.; Reinhold, Caroline. Abdominal imaging studies: comparison of diagnostic accuracies resulting from ultrasound, computed tomography, and magnetic resonance imaging in the same individual. Magnetic Resonance Imaging. 2004-01, 22 (1): 19–24 [2021-09-12]. doi:10.1016/j.mri.2003.01.001. (原始内容存档于2021-09-12). 
  16. ^ Berthold Block. Abdominal Ultrasound: Step by Step 2nd edition. Georg Thieme Verlag, Stuttgart, Germany: Thieme. 2012 [2021-09-12]. ISBN 9783131383631. (原始内容存档于2022-08-07). 
  17. ^ Miele, Vittorio; Piccolo, Claudia Lucia; Galluzzo, Michele; Ianniello, Stefania; Sessa, Barbara; Trinci, Margherita. Contrast-enhanced ultrasound (CEUS) in blunt abdominal trauma. The British Journal of Radiology. 2016-05, 89 (1061): 20150823 [2021-09-12]. doi:10.1259/bjr.20150823. (原始内容存档于2021-09-12). 
  18. ^ García de Casasola Sánchez, G.; Torres Macho, J.; Casas Rojo, J.M.; Cubo Romano, P.; Antón Santos, J.M.; Villena Garrido, V.; Diez Lobato, R. Abdominal Ultrasound and Medical Education. Revista Clínica Española (English Edition). 2014-04, 214 (3): 131–136 [2021-09-12]. doi:10.1016/j.rceng.2013.11.001. (原始内容存档于2021-09-12). 
  19. ^ Access to Assistive Technology and Medical Devices, Access to Medicines and Health Products, Health Product Policy and Standards, Medical Devices and Diagnostics. Elisabetta Buscarini, Harald Lutz and Paoletta Mirk , 编. Manual of diagnostic ultrasound 2nd ed. World Health Organization. 2013 [2021-09-12]. ISBN 9789241548540. (原始内容存档于2022-03-20). 
  20. ^ Simeone, Jf; Brink, Ja; Mueller, Pr; Compton, C; Hahn, Pf; Saini, S; Silverman, Sg; Tung, G; Ferrucci, Jt. The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign. American Journal of Roentgenology. 1989-02, 152 (2): 289–290 [2021-09-12]. PMID 2643262. doi:10.2214/ajr.152.2.289. (原始内容存档于2022-08-10). 
  21. ^ Benacerraf, B R; Shipp, T D; Bromley, B. Is a full bladder still necessary for pelvic sonography?. Journal of Ultrasound in Medicine. 2000-04, 19 (4): 237–241 [2021-09-12]. doi:10.7863/jum.2000.19.4.237. (原始内容存档于2021-09-12). 
  22. ^ NHS. Ultrasound scan. nhs.uk. 2017-10-18 [2021-09-12]. (原始内容存档于2022-10-19) (英语).