钡灌肠检查在诊断先天性巨结肠及明确肠管病变范围中的应用价值  

Diagnostic value of barium enema for Hirschsprung＇ s disease and confirming the extent of aganglionosis bowel

作　　者：朱天琦[1] 余东海[1] 向磊[1] 魏明发[1] 孙晓毅[1] 易斌[1] 冯杰雄[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030

出　　处：《中华小儿外科杂志》2015年第11期810-813,共4页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金（编号：81270441）

摘　　要：目的通过比较先天性巨结肠患儿术前钡灌肠检查与术后病理诊断的结果，探讨术前钡灌肠检查在先天性巨结肠的诊断，特别是确定肠管病变范围中的应用价值。方法本研究为单中心横向研究，研究对象为2014年1月至2015年1月入我院诊断为先天性巨结肠的患儿，钡灌肠检查显示明显狭窄段、移行段及扩张段的病例最终被纳入本次研究。在术中根据钡灌肠中移行段的前、后5cm分别取全层肠壁，利用PGP9．5染色检测其中神经节细胞，并以此作为金标准。如果病理检查提示无神经节细胞即为阳性。反之存在神经节细胞即为阴性。统计得出钡灌肠检查应用于明确肠管病变范围的敏感性、特异性、阳性预测值以及阴性预测值。结果共计56例纳入本次研究，平均年龄为13．7个月。利用钡灌肠显示的移行段明确术中肠管切除范围的敏感度为86．9％，特异度为94．1％，阳性预测值为94．6％，阴性预测值为85．7％，约登指数为81％。一致性检验Kappa值=0．804，P〈0．001。其中钡灌肠显示短段型巨结肠的最终病理诊断符合率为77．8％；常见型巨结肠的最终符合率为88．9％，长段型巨结肠的最终符合率为66．7%。结论钡灌肠对于诊断先天性巨结肠具有很好的预测价值，而且对于术中确定肠管病变范围也具有实际指导意义。Objective To explore the diagnostic value of barium enema film for Hirschsprung＇s disease （HD） and examine the correlation between radiological transition zone （TZ） and final pathology. Methods For this single-center cross-sectional study, a total of 56 patients with suspected HD undergoing barium enema and primary pull-through operations from January 2013 to January 20l 4 were reviewed. According to barium enema, full thickness bowel wall biopsies were performed before and after 5 cm of transitional zone. And the gold standard was detecting ganglion cell by PGP 9. 5 staining. If aganglionosis was considered positive whereas ganglionosis negative. The diagnostic parameters of sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of barium enema in the range of HD were analyzed by statistical software. Results Their average age was 13.7 months. The sensitivity of barium enema film was 86. 9% and specificity 94.1%. The value of PPV was 94.6% and that of NPV 85.7%. Youden index was 81%. Consistency checking Kappa value was 0. 804 （P〈 0. 001）. The diagnostic coincidence rate was 77. 8% in short-segment HD, 88.9% in normal-segment HD and 66. 7% in long-segment HD. Conclusions With a high diagnostic predictive value for HD, barium enema film is useful for confirming the involvement extent of aganglionosis bowel.

关 键 词：巨结肠 先天性 钡灌肠 儿童 

分 类 号：R726.5[医药卫生—儿科]