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目的评价99TcmO4-异位胃黏膜显像诊断小儿梅克尔憩室的价值。方法对有便血史、临床疑诊为梅克尔憩室的43例患儿行99TcmO4-异位胃黏膜显像。显像前禁饮食4 h以上,静脉注射99TcmO4-(111~185 MBq)后立即动态及30 min、1 h、2 h静态采集图像。23例患儿行小肠造影。将99TCmO4-显像结果与小肠造影结果及临床最终诊断结果进行对比、评价、分析。结果 43例患儿中99TcmO4-异位胃黏膜显像阳性且核医学医师诊断为梅克尔憩室27例,其中术后病理证实为梅克尔憩室26例,肠重复畸形1例。阴性16例中3例为梅克尔憩室,13例非梅克尔憩室。诊断灵敏度为89.7%,特异性为92.9%,阳性预测值为96.3%。阳性病例影像多表现为动态影像上与胃同时或稍晚出现异常核素浓聚灶,多位于右腹股沟区,呈圆形或类圆形,随时间延长渐增浓;静态影像上仍可见该浓聚灶,随时间延长其位置、形态、大小变化不大。99TcmO4-异位胃黏膜显像与小肠造影比较,诊断灵敏度(χ2=3.08,P>0.05)、特异性(χ2=0.28,P>0.05)差异均无统计学意义。结论 99TcmO4-异位胃黏膜显像诊断梅克尔憩室灵敏度、特异性高,无创、安全、简便且无痛苦,应作为诊断梅克尔憩室并出血的首选影像学方法。
Objective To evaluate the value of 99TcmO4-ectopic gastric mucosa in the diagnosis of children with Merkel’s diverticulum. Methods To have a history of hematochezia, clinical suspected diagnosis of Meckel diverticulum in 43 cases of children with 99TcmO4-ectopic gastric mucosa imaging. Imaging before the banned diet for more than 4 h, intravenous 99TcmO4- (111 ~ 185 MBq) immediately after the dynamic and 30 min, 1 h, 2 h static collection of images. Twenty-three children underwent small bowel radiography. 99TCmO4- imaging results and the results of small bowel and clinical final diagnostic results were compared, evaluation, analysis. Results Of the 43 cases, 99TcmO4-ectopic gastric mucosa was positive and nuclear medicine was diagnosed as Meckel’s diverticulum in 27 cases. Postoperative pathology confirmed 26 cases of Meckel’s diverticulum and 1 case of intestinal deformity. Negative 16 cases, 3 cases of Merkel diverticulum, 13 cases of non-Merkel diverticulum. The diagnostic sensitivity was 89.7%, the specificity was 92.9%, and the positive predictive value was 96.3%. In the positive cases, the abnormal images of the radionuclide imaging showed more or less abnormal concentration of radionuclides at the same time or later in the dynamic image, mostly in the right groin area, which was round or round and gradually thicken with time, still visible on the still images Focus stove, with the extension of its location, shape, size, little change. There was no significant difference in diagnostic sensitivity (χ2 = 3.08, P> 0.05) and specificity (χ2 = 0.28, P> 0.05) between 99TcmO4-ectopic gastric mucosa imaging and small bowel radiography. Conclusions 99TcmO4-ectopic gastric mucosa imaging is the first choice for the diagnosis of Meckel’s diverticulum and bleeding because of its sensitivity, specificity, noninvasiveness, safety, convenience and painlessness.