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

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.