3种辅助检查在496例儿童先天性巨结肠诊断中的比较研究

Application of three auxiliary examinations in the diagnosis of 496 children with Hirschsprung’s disease：A comparative study

摘要:

目的：探讨钡剂灌肠（contrast enema，CE）、肛直肠测压（anorectal manometry，ARM）及直肠黏膜活检（rectal suction biopsy，RSB）在先天性巨结肠（Hirschsprung’s disease，HD）术前辅助检查的应用及意义。方法：回顾性分析我院496例HD患儿的年龄、辅助检查结果及临床病理报告等病历资料，按年龄和病理类型分组，主要采用卡方检验分析并总结CE、ARM、RSB 3种术前检查的灵敏度比较结果。结果：按年龄分组，①0~28 d组，RSB和ARM诊断灵敏度明显高于CE（n=80， ?字2=14.060，P=0.000；n=68， ?字2=9.620，P=0.001）；28~90 d组，CE、ARM与RSB之间灵敏度差异无统计学意义（P＞0.017）；90 d~3岁组263例，RSB灵敏度明显高于CE和ARM（n=148， ?字2=13.070， ?字2=15.060，P=0.000）。②ARM在0~28 d组灵敏度明显高于3岁以上组（ ?字2=8.780，P＜0.05）。③而RSB和CE检查在4个年龄组之间的差异无统计学意义（P＞0.05）。按病理类型分组，①短段型HD组，RSB诊断灵敏度明显高于CE（n=40， ?字2=5.140，P=0.016）；常见型HD组，RSB诊断灵敏度均明显高于ARM和CE（n=197， ?字2=16.060， ?字2=18.050，P=0.000）；长段型HD组，RSB诊断灵敏度明显高于ARM和CE（n=70， ?字2=13.070，P=0.000； ?字2=9.090，P=0.001）。②CE在短段型诊断灵敏度明显低于常见型（ ?字2=8.670，P＜0.05）。ARM在长段型诊断灵敏度明显低于常见型（ ?字2=7.930，P＜0.05），RSB在各类型之间灵敏度差异无统计学意义（P＞0.008）。③CE检查在四种不同病理类型HD之间对痉挛段位置的判断，长段型准确率明显低于短段型和常见型（ ?字2=13.880； ?字2=10.330，P＜0.05）。结论：CE、ARM及RSB术是诊断HD常用的辅助检查手段，相比较而言，CE对于常见型HD的诊断灵敏度较高，而患儿年龄对其影响不大；ARM对于常见型HD的诊断灵敏度同样较高，而患儿年龄越小其诊断灵敏度越高；RSB诊断灵敏度不受年龄影响，而在短段型HD中较低。CE对HD痉挛段实际位置描述的准确性在短段型和常见型中较高。

Abstract:

Objective：To investigate the application of contrast enema（CE），anorectal manometry（ARM），and rectal suction biopsy （RSB） in the preoperative auxiliary examination of Hirschsprung’s disease（HD） and its significance. Methods：A retrospective analysis was conducted on 496 children with HD in our hospital based on their medical records including age，auxiliary examination results，and clinical pathology reports. The patients were grouped according to their age and pathological types，and were compared for the sensitivity of the above three preoperative examinations using chi-square test. Results：For comparison between different age groups，the diagnostic sensitivity of RSB and ARM was significantly higher than that of CE in the 0- to 28-day group（n=80 and n=68， ?字2=14.060 and 9.620，P=0.000 and 0.001，respectively）；there were no significant differences in sensitivity between CE，ARM，and RSB in the 28- to 90-day group（P>0.017）；the sensitivity of RSB was significantly higher than that of CE and ARM in the 90-day to 3-year-old group（n=148， ?字2=13.070 and 15.060，P=0.000）；the sensitivity of ARM was significantly higher in the 0- to 28-day group than in the 3-year-old to older age group（ ?字2=8.780，P<0.05）；there were no significant differences in sensitivity between RSB and CE across the four age groups（P>0.05）. For comparison between different groups by pathological types，the diagnostic sensitivity of RSB was significantly higher than that of CE in the short-segment HD group（n=40， ?字2=5.140，P=0.016）；the diagnostic sensitivity of RSB was significantly higher than that of ARM and CE both in the normal-segment HD group（n=197， ?字2=16.060 and 18.050，P=0.000） and in the long-segment HD group（n=70， ?字2=13.070 and 9.090，P=0.000 and 0.001，respectively）；the diagnostic sensitivity of CE was significantly lower in the short-segment HD group than in the normal-segment HD group（ ?字2=8.670，P<0.05）；the diagnostic sensitivity of ARM was significantly lower in the long-segment HD group than in the normal-segment HD group（ ?字2=7.930，P<0.05）；there were no significant differences in the sensitivity of RSB between all the different groups by HD types（P>0.008）；CE examination showed significantly lower accuracy in the long-segment HD group than in the short-segment HD and the normal-segment HD groups in terms of locating the spasmodic segment across four different pathological types of HD（ ?字2=13.880 and 10.330，P<0.05）. Conclusion：CE，ARM，and RSB are commonly used auxiliary examinations in the diagnosis of HD. Comparatively speaking，CE shows a relatively high diagnostic sensitivity for normal-segment HD（with negligible effect of patient’s age） and a relatively high accuracy in locating the spasmodic segment for short-segment and normal-segment HD；ARM shows a relatively high diagnostic sensitivity for normal-segment HD just as CE，with increased sensitivity as patient’s age decreases；the diagnostic sensitivity of RSB is not affected by age，but is relatively low in short-segment HD.