探讨新生儿期膈疝的超声声像图特点。

选择2000年1月至2017年12月首都医科大学附属北京儿童医院超声及手术病理检查确诊为新生儿期膈疝的患儿19例，平均出生（12.8±11.7）d，其中3例产前已诊断膈疝，11例表现为呼吸困难，3例表现为呕吐，2例表现为心动过速。总结19例新生儿超声声像图特点。

19例新生儿膈疝术前超声显示自左侧胸腔内疝入小肠4例，胃底2例，脾脏3例，1例疝入物为左侧肾上腺及左肾上极；右侧胸腔内疝入肠管3例，4例疝入物为部分肝脏右叶及胆囊，2例疝入物为右肾上腺及右肾。食道裂孔疝疝入物均为胃。后外侧疝表现为膈肌不连续，位于腹腔内或腹膜后的脏器通过不连续的膈肌进入胸腔水平。食道裂孔疝表现为胃体通过食管裂孔疝入胸腔。术前超声诊断后外侧疝16例，食道裂孔疝2例，1例膈疝与膈膨升不能鉴别。与术前相关影像及手术检查结果对照，术前超声诊断符合率为94.74%（18/19）。

新生儿期患儿胸壁软组织薄，超声检查可清晰实时多角度显示膈肌情况，诊断符合率不低于CT或磁共振成像，且无放射性损伤，是新生儿期膈疝患儿首选的影像学检查方法。

To discuss ultrasound image features of neonatal congenital diaphragmatic hernia (CDH), and to improve the neonatal diagnosis of the disease by ultrasound.

There were 19 neonatal patients who were diagnosed as CDH by ultrasound from January 2000 to September 2017, and those diagnoses were confirmed by operation and pathology. The average age of patients were (12.8±11.7) days. Of them, 3 cases had been successfully diagnosed as diaphragmatic hernia in prenatal ultrasound. In clinical manifestations, 11 cases had dyspnea, 3 cases had vomiting and 2 cases had tachycardia. The ultrasonic images features of CDH were summarized.

Nineteen cases of neonatal diaphragmatic hernia were diagnosed correctly by ultrasound. There were 16 cases of posterolateral hernia, 2 cases of esophageal hiatal hernia, and 1 case with difficulty in distinguishing between diaphragmatic hernia and eventration of the diaphragm. The diagnostic accuracy rate was 94.74% (18/19). There were herniated content were small intestine herniated to left thoracic cavity in 4 cases, stomach fundus in 2 cases, spleen herniated in 3 cases, left adrenal gland and upper pole of left renal in 1 case, small intestine from the abdominal cavity herniated to right thoracic cavity in 3 cases, part of right lobe liver with gallbladder herniated to thoracic cavity in 4 cases, and right adrenal gland and the right kidney in 2 cases. The herniated content of the esophageal hiatus hernia were stomach in all cases. Ultrasound image features of CDH of posterolateral hernia were discontinued diaphragm, through which the abdominal and retroperitoneal organs herniated into the chest cavity. Ultrasound image features of CDH of esophageal hiatus hernia were the herniation of gastrointestinal tract into the chest cavity through esophageal fissure.

Ultrasonic examination can clearly display the diaphragm in real time, and the diagnostic accuracy is comparable to that of CT and MR. As a non-radiative approach, ultrasound should be the first choice of imaging examination in diagnosing CDH for neonate.