先天性巨结肠与巨结肠类缘病的临床及影像学对比研究  

The clinical and radiologic features of the Hirschsprung disease and the Hirschsprung allied disease：a comparative study

作　　者：冯红梅[1] 洪居陆[1] 何耀强[1] 杨冠英[1] 朱彬[1] 高明勇[1] 

机构地区：[1]佛山市第一人民医院影像科,广东佛山528000

出　　处：《实用放射学杂志》2015年第5期785-788,共4页Journal of Practical Radiology

摘　　要：目的：对先天性巨结肠（HD）与巨结肠类缘病（HAD）的临床及影像表现进行对比分析，以提高两者鉴别诊断水平。方法对病理证实的 HD（A 组）和 HAD（B 组）各20例患儿的临床及影像表现回顾性分析，记录出生时胎粪排出、病情反复、辅助排便、肛门指检等临床情况．分析钡灌肠图像是否存在痉挛段、移行段，测量扩张段肠腔内径、扩张段远端肠壁夹角等指标，并对相关数据进行统计学处理。结果2组患儿的年龄、性别，临床表现如病情反复、排便困难或便秘、腹胀、肠鸣音活跃、辅助排便及胎粪排出延迟等，差别均无统计学意义。2组腹痛出现概率的差异有统计学意义。肛门指检发现肛门不能容纳一小指，2组发生概率的差别无统计学意义；拔指后有气便排出，2组发生概率的差别有统计学意义。钡灌肠表现，2组痉挛段出现概率、24h后复查钡剂残留的出现概率及扩张段肠管内径的差别均无统计学意义。2组移行段出现概率及扩张段远端肠壁夹角差别有统计学意义。结论HD和HAD临床表现极其相似；肛门指检拔指后是否有气便排出，钡灌肠是否存在移行段及扩张段远端肠壁夹角大小，有助于HD与HAD鉴别诊断。Objective To study the clinical and barium enema （BE）features of the Hirschsprung allied disease （HAD）and the Hirschsprung disease （HD）,in order to improve the differential diagnosis between them.Methods Retrospective study was per-formed on the clinical and BE findings in 20 patients with HD （group A）and in other 20 patients with HAD （group B）confirmed by pathology.The clinical manifestations of two diseases such as birth meconium,repeated illness,assisted defecate,and rectal exami-nation were evaluated.On BE images,a cramps period and a transitional period of bowel,internal diameter of the expansion section and bowel wall of the distal of expansion section were assessed.And then,the statistical analysis in all above related data was per-formed.Results No statistical differences were observed in HAD and HD patients’age,sex and clinical manifestations including disease recurrence,defecation difficulties or constipation,bloating,bowel sounds activity,assisted defecate and meconium delay. Whereas,there was statistical difference in the incidence of abdominal pain.The difference of incidence rate of anus with the space less than a pinky between the two diseases wasn’t statistically significant.The incidence rate of gas and/or feces discharged from the anus after pulling out pinky was statistically different.In addition,there were no statistical differences in the incidence rate of the stenosis zone and the barium retained after 24 hours,and the internal diameter of expansion bowel between them.The differences in incidence rate of the transitional zone and the angle of the intestinal wall between the distal part of the expansion zone in two groups were statistically significant.Conclusion The clinical manifestations of HD and HAD are similar.The gas and/or feces discharged from the anus after pulling out pinky,the lower incidence of transitional zone,and the angle of the intestinal wall between the distal part of the expansion zone and the transition zone are likely to contribute to HAD diagno

关 键 词：先天性巨结肠 巨结肠类缘病 儿童 钡灌肠 

分 类 号：R574.62[医药卫生—消化系统] R814.43[医药卫生—内科学]