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 编辑

 
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英语Hemodynamics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 编辑

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 编辑

 
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英语hepatomegaly[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 编辑

 
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 编辑

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 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). 
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  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
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  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). 
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