MRI造影和X线造影对先天性肛门直肠畸形合并瘘的诊断价值  

Diagnostic Accuracy of MRI and X-ray Distal Colostogram in Congenital Anorectal Malformations Combined with Fistulae:a Comparative Study

作　　者：朱才娣[1] 周俊霖[1] 黄素华[1] 丁山[1] 吴主强[1] 黄冰[1] ZHU Cai-di;ZHOU Jun-lin;HUANG Su-hua;DING Shan;WU Zhu-qiang;HUANG Bing(Department of Radiology,Jiangxi Provincial Children’s Hospital/the Affiliated Children’s Hospital of Nanchang Medical College,Nanchang 330006,China)

机构地区：[1]江西省儿童医院、南昌医学院附属儿童医院影像中心,南昌330006

出　　处：《实用临床医学（江西）》2024年第2期70-73,F0004,共5页Practical Clinical Medicine

基　　金：江西省重点研发计划项目(2016IBBG70146);江西省卫计委科技计划项目(20161123)。

摘　　要：目的探讨MRI造影和X线造影对先天性肛门直肠畸形(CARM)合并瘘的诊断价值。方法收集29例在江西省儿童医院就诊并治疗肛门直肠畸形一期造瘘后患儿,对所有患儿同时行MRI造影检查和X线造影检查,分析直肠形态、瘘的有无及瘘的类型,比较2种检查方法对CARM患儿瘘的诊断准确率。结果29例CARM造瘘后患儿在术中探查均有瘘管。在MRI结肠造影结果中,26例见瘘管,显示瘘管的走形及瘘管类型;3例显示不清,为泄殖腔畸形2例及阴道瘘1例。在X线造影结果中,24例显示瘘管;5例未显示瘘管,为尿道前列腺部瘘3例,直肠尿道球部瘘2例,均显示直肠远端呈鸟嘴样改变。X线造影对CARM瘘管诊断准确率为82.75%(24/29),MRI造影诊断准确率为89.7%(26/29),二者比较差异无统计学意义(χ^(2)=0.706,P=0.353)。结论MRI造影检查可以很好一显示直肠形态、瘘管开口、类型,无放射性伤害,与X线结肠造影检查结果相似,且能提供更详细的肛门直肠解剖,为临床手术方式的选择提供重要的信息。Objective To compare diagnostic accuracy between MRI and X-ray distal colostogram in patients with congenital anorectal malformations(CARM)combined with fistulae.Methods 29 children who underwent colostomy and treatment of anorectal malformation phase I fistula in Jiangxi Provincial Children’s Hospital were selected for the study.MRI and X-ray distal colostogram were performed on all the children to analyze rectal morphology,the presence or absence of fistulae,and the types of fistulae.The diagnostic accuracy of the two examinations for fistulae in children with CARM were analyzed and compared.Results All 29 children with CARM after colostomy had fistulae on intraoperative exploration.From MRI distal colostogram,fistulae,the alignment of fistulae and the type of fistulae were seen in 26 cases;in 3 cases,fistulae were not seen(cloacal malformation in 2 cases and rectovaginal fistula in 1 case).From X-ray distal colostogram,fistulas were seen in 24 cases and they were not seen in 5 cases;among the 5 unseen fistulas,3 cases were urethro-prostatic fistulae and 2 cases were rectourethral bulbous fistulas,all showing bird’s beak-like changes in the distal part of the rectum.The X-ray diagnostic accuracy for CARM fistula was 82.75%(24/29),and the MRI diagnostic accuracy was 89.7%(26/29).The differences were not statistically significant(χ^(2)=0.706,P>0.353).Conclusion MRI distal colostogram can reveal rectal morphology,fistula opening,and type of fistulae without radioactive damage,similar to the results of X-ray colostogram,and it can provide more detailed anorectal anatomy for the selection of clinical surgery.

关 键 词：MRI造影 先天性肛门直肠畸形 瘘 X线造影 

分 类 号：R726.5[医药卫生—儿科] R445[医药卫生—临床医学]