超声与倒立位X线片对男性中高位先天性肛门直肠畸形的诊断效能比较  

Comparison of diagnostic efficacy in males with high/intermediate typed anorectal ma lformations between ultrasound and inverted X-ray exam

作　　者：袁鹏 侯金平[1] 王佚[1] YUAN Peng;HOU Jinping;WANG Yi(Department of Genera and Neonata Surgery Laboratory of ChidDeveopment and Disorders of Ministry of Education Nationa Cinica Research Center for Chid Heath and Disorders Chongqing Key Laboratory of Pediatrics,Children’s Hospital of Chongqing Medical University,Chongqing,400014,China)

机构地区：[1]重庆医科大学附属儿童医院普外新生儿外科,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《陆军军医大学学报》2023年第11期1197-1203,共7页Journal of Army Medical University

基　　金：重庆市自然科学基金(cstc2018jcyjAX0230);重庆市科卫联合医学科研项目(2019ZDXM021)。

摘　　要：目的比较超声与倒立位X片鉴别男性中高位肛门直肠畸形(anorectal malformations,ARMs)的诊断效能。方法本研究设计方案为完全配对设计的诊断准确性试验。选取2013年3月至2022年3月于重庆医科大学附属儿童医院收治的146例男性中高位ARMs患儿临床资料,根据肛门成形术后诊断分为高位和中位组,其中高位组55例(膀胱颈部瘘12例、尿道前列腺部瘘43例),中位组91例(尿道球部瘘65例、无瘘26例)。以直肠-肛隐窝距离(pouch-perineum distance,P-Pe distance)为测量指标,以诊断准确度、敏感度、特异性与ROC曲线下面积(area under the subject curve,AUC)为评价指标,对两种方法的诊断效能进行ROC配对分析及确定两种方法的最佳诊断界值,并对两种影像学方法在不同时间段的诊断价值进行比较。结果两种检查方法均能有效鉴别中位与高位男性ARMs(均P<0.05)。超声的AUC(0.835,95%CI:0.764~0.891)高于倒立位X片(0.759,95%CI:0.681~0.826),但二者差异无统计学意义(P=0.061)。超声的诊断界值(15.0 mm)小于倒立位X片(24.0 mm)。当检查时间大于生后48 h时,超声诊断效能(0.940,95%CI:0.799~0.993)大于倒立位X片(0.758,95%CI:0.578~0.890),且差异具有统计学意义(P=0.032)。结论超声及倒立位X片均能有效鉴别男性中高位ARMs。当检查时间大于生后48 h时,更推荐使用超声。Objective To compare the diagnostic efficacy of ultrasound and inverted X-ray in differentiating high and intermediate types of male anorectal malformations(ARMs).Methods A fully paired diagnostic accuracy study was conducted on 146 male children with intermediate/high type ARMs who were treated in our hospital from March 2013 to March 2022.According to their postoperative diagnosis after anorectal plasty,55 cases(including 12 with bladder-neck fistula and 43 with urethral-prostatic fistula)were assigned into high type group and 91 cases(including 65 with urethral-bulbar fistula and 26 without fistula)into intermediate type group.The accuracy,sensitivity,specificity,and area under the curve(AUC)were used as evaluation indicators to compare the diagnostic efficacy of 2 examinations and the optimal diagnostic cutoff values by receiver operating characteristic(ROC)curve analysis.And the diagnostic efficacy of ultrasound and inverted X-ray was then compared in different time periods after birth.Results Both examinations effectively differentiated high and intermediate types of male ARMs(P<0.05).The ROC curve analysis showed that the AUC of ultrasound(0.835,95%CI:0.764~0.891)was higher than that of inverted X-ray(0.759,95%CI:0.681~0.826),though without significant difference(P=0.061).The cut-off value of ultrasound(15.0 mm)was shorter than that of inverted X-ray(24.0 mm).The diagnostic efficacy of ultrasound(0.940,95%CI:0.799~0.993)was significant higher than that of inverted X-ray(0.758,95%CI:0.578~0.890)when inspection time was longer than 48 h after birth(P=0.032).Conclusion Both ultrasound and inverted X-ray can differentiate intermediate and high type ARMs in male neonates.Ultrasound is more recommended for the neonates older than 48 h.

关 键 词：肛门直肠畸形 影像诊断 超声 新生儿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R445.4[医药卫生—诊断学] R574.63[医药卫生—临床医学]