超声与倒立位X线诊断先天性肛门直肠畸形的一致性研究  

The consistency of ultrasound and inverted X-ray in diagnosis of congenital anorectal malformation

作　　者：胡慧勇[1] 许云峰[1] 丁亮 蒋海燕[1] 王海荣[1] 耿天笑 侯艳青 HU Huiyong;XU Yunfeng;DING Liang;JIANG Haiyan;WANG Hairong;GENG Tianxiao;HOU Yanqing(Department of Ultrasound,Shanghai Children’s Hospital,Shanghai Jiaotong University,Shanghai 200062,P.R.China;Department of Ultrasound,Shandong Maternal and Child Health Hospital,Jinan 250000,P.R.China)

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院超声科,上海200062 [2]山东省妇幼保健院超声科,山东济南250000

出　　处：《医学影像学杂志》2019年第1期112-115,共4页Journal of Medical Imaging

摘　　要：目的探讨超声和倒立位X线对先天性肛门直肠畸形(CARM)的诊断价值,比较两种检查方法的一致性。方法回顾性分析48例先天性肛门直肠畸形患儿的临床资料、超声和倒立位X线检查结果,依据手术结果分为低位组(n=21)和中高位组(n=27),分组比较两组性别、有无瘘管、超声测量直肠盲端至肛门隐窝的距离(P-Pe间距)、倒立位X线测量P-Pe距离、超声和倒立位X线诊断符合率,并采用Kappa检验分析超声和倒立位X线诊断CARM的一致性。结果低位组男性(17例)多于女性(4例),中高位组女性(14例)略多于男性(13例),两组间男女性别差异有统计学意义(X^2=5. 424,P=0. 020);低位组瘘管(15例)多于中高位组(11例),差异有统计学意义(X^2=4. 481,P=0. 034);低位组超声测量P-Pe间距平均值(6. 82±4. 03) mm小于X线倒立位测量P-Pe间距平均值(11. 64±5. 98) mm,差异有统计学意义(t=6. 691,P=0. 000);中高位组超声测量P-Pe间距平均值(18. 83±5. 54) mm小于X线倒立位测量P-Pe间距平均值(23. 78±6. 79) mm,差异有统计学意义(t=4. 988,P=0. 002);超声和倒立位X线在诊断低位和中高位CARM差异均无统计学意义(均P> 0. 05);与手术结果比较,超声和倒立位X线诊断CARM有一致性(Kappa=0. 458,P=0. 001),超声诊断CARM准确率93. 8%,X线诊断CARM准确率89. 6%,差别无统计学意义(P=0. 625)。结论超声和倒立位X线检查诊断CARM准确率较高,两种检查方法有一致性。超声还具有无损伤无辐射,检查不受限制,不必倒置,也不受体位和时间的影响等优点,应作为CARM的首选检查方式。Objective To evaluate the diagnostic value of ultrasound and inverted X-ray in congenital anorectal malformation(CARM)and to compare the consistency of the two methods.Methods The clinical data,ultrasound and inverted X-ray findings of 48 children with congenital anorectal malformation were analyzed retrospectively.According to the results of surgery,the patients were divided into low type group(n=21)and intermediate-high type group(n=27).The two groups were compared for gender,the presence of fistula,the ultrasonic measurement of the distance between the distal rectal pouch and the perineum(P-Pe distance),the inverted X-ray measurement of the P-Pe distance,diagnostic coincidence rate of ultrasound and inverted X-ray,and kappa test was used to analyze the consistency of ultrasound and inverted radiography diagnosis of CARM.Results There were more males than females in the low type group,slightly more females than males in the intermediate-high type group,the gender difference between the two groups was statistically significant(2=5.424,P=0.020);There were more fistulas in the low type group than in the intermediate-high type group,with statistically significant(2=4.481,P=0.034);In the low type group,the mean P-Pe distance measured by ultrasound(6.82±4.03)mm was samller than the mean P-Pe distance(11.64±5.98)mm measured by inverted X-ray,the difference between the two groups was statistically significant(t=6.691,P=0.000);In the intermediate-high type group,the mean P-Pe distance(18.83±5.54)mm measured by ultrasound was smaller than the mean P-Pe distance(23.78±6.79)mm measured by inverted X-ray,and the difference between the two groups was statistically significant(t=4.988,P=0.000);Ultrasound and inverted X-ray showed no significant difference in the diagnosis of low type and intermediate-high type CARM(all P﹥0.05);Compared with the results of surgery,ultrasound and inverted X-ray diagnosis of CARM was consistent(Kappa=0.458,P=0.001),the accuracy of ultrasonic diagnosis of CARM was 93.8%,and the accuracy rat

关 键 词：先天性肛门直肠畸形 儿童 超声检查 倒立位X线诊断 

分 类 号：R726.2[医药卫生—儿科] R445.1[医药卫生—临床医学]