腹部超声波

腹部超声波检查
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-CM	88.76
OPS-301（英语：OPS-301）	3-059
MedlinePlus	003777

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。

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腹部超声波检查通常由肠胃科、内科或放射科医生进行，亦可由超声波技师（英语：Sonographer）进行。

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与胎儿；这类检查称为产科超声波（英语：Obstetric ultrasonography）^[2]^[3]。

当病患出现腹痛或急性腹痛（英语：Acute abdomen），腹部超声波可用于诊断病者是否患上阑尾炎及胆囊炎，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。

结石检查

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、针刺活检及腹部穿刺引流（英语：Paracentesis）（通过针刺从腹腔中抽走积水的治疗）等等^[9]。

肝脏

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、肝脏肿瘤等^[13]。

肾脏超声波

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]

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]。

[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]
Timothy Jang. Bedside Ultrasonography Evaluation of Abdominal Aortic Aneurysm - Technique. Medscape（英语：Medscape）. 2017-08-28.
[7]
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
- Putukian, M; O'Connor, FG; Stricker, P; McGrew, C; Hosey, RG; Gordon, SM; Kinderknecht, J; Kriss, V; Landry, G. Mononucleosis and athletic participation: an evidence-based subject review. Clinical Journal of Sport Medicine. 2008-07, 18 (4): 309–15. PMID 18614881. doi:10.1097/JSM.0b013e31817e34f8.
- Spielmann, AL; DeLong, DM; Kliewer, MA. Sonographic evaluation of spleen size in tall healthy athletes.. AJR. American Journal of Roentgenology. 2005-01, 184 (1): 45–9. PMID 15615949. doi:10.2214/ajr.184.1.01840045.
[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）.

[Bisset2008-1] [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] [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] [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] [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] [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）.

[medscape-6] [6]
Timothy Jang. Bedside Ultrasonography Evaluation of Abdominal Aortic Aneurysm - Technique. Medscape（英语：Medscape）. 2017-08-28.

[AMSSMfive-7] [7]
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
Putukian, M; O'Connor, FG; Stricker, P; McGrew, C; Hosey, RG; Gordon, SM; Kinderknecht, J; Kriss, V; Landry, G. Mononucleosis and athletic participation: an evidence-based subject review. Clinical Journal of Sport Medicine. 2008-07, 18 (4): 309–15. PMID 18614881. doi:10.1097/JSM.0b013e31817e34f8.

Spielmann, AL; DeLong, DM; Kliewer, MA. Sonographic evaluation of spleen size in tall healthy athletes.. AJR. American Journal of Roentgenology. 2005-01, 184 (1): 45–9. PMID 15615949. doi:10.2214/ajr.184.1.01840045.

[8] Putukian, M; O'Connor, FG; Stricker, P; McGrew, C; Hosey, RG; Gordon, SM; Kinderknecht, J; Kriss, V; Landry, G. Mononucleosis and athletic participation: an evidence-based subject review. Clinical Journal of Sport Medicine. 2008-07, 18 (4): 309–15. PMID 18614881. doi:10.1097/JSM.0b013e31817e34f8.

[9] Spielmann, AL; DeLong, DM; Kliewer, MA. Sonographic evaluation of spleen size in tall healthy athletes.. AJR. American Journal of Roentgenology. 2005-01, 184 (1): 45–9. PMID 15615949. doi:10.2214/ajr.184.1.01840045.

[8] [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] [9]
Dogra, Vikram.; Saad, Wael E. A. Ultrasound-guided procedures. New York, NY: Thieme. 2010. ISBN 9781604061703.

[efsumb2010-10] [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] [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] [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] [13]
Janice Hickey, Franklin Goldberg. Ultrasound review of the abdomen, male pelvis & small parts. Philadelphia : Lippincott. 1999. ISBN 0397516916.

[Hansen2015-14] [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] [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] [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] [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] [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] [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] [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] [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] [22]
NHS. Ultrasound scan. nhs.uk. 2017-10-18 [2021-09-12]. （原始内容存档于2022-10-19）（英语）.

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结石检查

肝脏

肾脏超声波

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腹部超声波

结石检查

肝脏

肾脏超声波

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用途

技术特点

参考资料