新生儿先天性巨结肠不典型X线征群的探讨  

The atypical roentgenographic signs of Hirschsprung′s disease in neonates

作　　者：沈全力[1] 李国平[1] 帕米尔[1] 

机构地区：[1]复旦大学附属儿童医院放射科,上海200032

出　　处：《中华放射学杂志》2003年第10期939-944,共6页Chinese Journal of Radiology

摘　　要：目的　探讨新生儿先天性巨结肠不典型X线征群的诊断价值。方法　搜集经手术和病理证实的 36例先天性巨结肠新生儿 ,设为病例组 ;对照组为同期亦经手术和病理证实的 37例非先天性巨结肠新生儿。对他们的腹部平片和钡剂灌肠结果进行对照研究。结果　新生儿先天性巨结肠腹部平片多表现为结肠低位梗阻和肠淤张 (2 3例 ,占 70 % ) ,少部分表现为小肠低位梗阻 (9例 ,占2 7% ) ,与对照组比较差异无显著性意义 (P >0 0 5 )。阴性表现者 1例 ,与对照组比较 ,差异具有显著性意义 (P <0 0 5 )。直肠下端局限性切迹 (13例 )、直肠和下段乙状结肠螺旋形或不规则大锯齿状收缩 (8例 )、2 4h随访钡剂潴留 (18例 )、结肠炎表现 (11例 )、结肠空肠化 (4例 )、钡粪相混征 (18例 )和胎儿型结肠 (6例 )为钡剂灌肠不典型征群。前 3者在病例组和对照组比较 ,差异具有非常显著性意义 (P <0 0 1) ;后 3者差异无显著性意义 (P >0 0 5 )。局限性切迹、直肠和下段乙状结肠螺旋形或不规则大锯齿状收缩、2 4h随访钡剂潴留 3个钡剂灌肠征象对新生儿先天性巨结肠的诊断敏感度分别为 38%、2 4 %、5 3% ;特异度分别为 95 %、10 0 %、78% ;正确指数 (Youden指数 )分别为 0 33、0 2 4、0 31。结论　直肠下端局限性切迹、直肠和下段乙?Objective To discuss the diagnostic value of atypical roentgenographic characters of Hirschsprung′s disease in neonates Methods The cases were collected for this study from a list of 73 neonates who had colonic surgery or rectal biopsy The clinical pictures of them were vomitus, abdominal distention, and failure to pass meconium They were divided into two groups One group consisted 36 cases of proved Hirschsprung′s disease, and the other group consisted 37 cases of disproved Hirschsprung′s disease Their abdominal X-ray plain films and barium enema references were retrospectively analyzed. Among 36 cases of Hirschsprung′s disease, 33 cases obtained abdominal X-ray plain films (supine and erect lateral or recumbent lateral projections) and 34 cases obtained barium enema examinations. Among 37 cases of disproved Hirschsprung′s disease, 18 cases obtained abdominal X-ray plain films and all of the 37 cases obtained barium enema examinations. Results The main manifestations of abdominal X-ray plain films in the cases of Hirschsprung′s disease were low colonic obstruction and intestinal distention (23 cases, 70%), part of the cases showed low small intestinal obstruction (9 cases, 27%). There was no statistical difference between the two groups (P>0.05). One case′s abdominal X-ray plain film of Hirschsprung′s disease showed normal (P<0.05). The barium enema examination characters were as follows. In the group of Hirschsprung′s disease, 13 cases revealed local notch of the distal rectum and only 2 cases showed this sign in the other group (P<0.01). Its sensitivity was 38%, specificity was 95%, and the Youden′s index was 0.33. 8 cases of Hirschsprung′s disease showed spiral or irregular bizarre saw-toothed contractions of the rectum and distal sigmoid colon, no case of the other group showed this sign (P<0.01). Its sensitivity was 24%, specificity was 100%, and the Youden′s index was 0.24. 18 cases of Hirschsprung′s disease showed barium retention after 24 hours follow-up, in the oth

关 键 词：新生儿 先天性巨结肠 不典型X线征群 诊断 腹部平片 

分 类 号：R816.92[医药卫生—放射医学]