| 摘要: |
| 目的 术前评估抱立位及仰卧位超声与倒立位X线对先天性肛门直肠畸形诊断一致性及准确性。方法122例临床诊断为先天性肛门直肠畸形患儿(分低位组和中高位组),术前应用抱立位超声、仰卧位超声及倒立位X线对直肠盲端至肛门隐窝皮肤距离(P-Pe间距)进行测量,比较三种检查方法与术后诊断一致性,分析三种检查方法对P-Pe测量精确性。 结果 抱立位超声、仰卧位超声、倒立位X线测量结果的灵敏度分别为97.18%、91.54%、77.64%；特异度分别为96.08%、96.08%、98.04%；符合率分别为96.72%、93.44%、86.07%；Kappa值分别为0.933、0.867、0.725,抱立位超声、仰卧位超声、倒立位X线的ROC曲线下面积分别为0.992、0.987、0.972,经一致性检验有统计学意义(均P＜0.001)。经过两两比较,中高位组患儿倒立位X线测量结果高于手术方式测量值(P＜0.05),抱立位超声、仰卧位超声测量结果与手术方式测量值差异无统计学意义(P＞0.05)。经完全随机设计资料的方差分析,低位组时四种不同方法测量值的均数不同(F=46.36,P ＜0.001)；经多个样本均数间两两比较的Dunnett检验,低位组患儿仰卧位超声、倒立位X线测量结果均高于手术测量值(P＜0.05),抱立位超声与手术测量值差异无统计学意义(P＞0.05)。结论 中高位组,不同体位下超声(抱立位和仰卧位)与X线定位诊断CARM准确性及测值均较高；低位组,超声诊断优于倒立位X线,采用抱立位超声具有更精确的测量及定位价值,力求为外科手术方式的选择提供强有力的依据。 |
| 关键词: 先天性肛门直肠畸形 抱立位超声 仰卧位超声 倒立位X线 |
| DOI： |
| 投稿时间：2022-01-20修订日期：2022-06-02 |
| 基金项目:] 甘肃省青年科技基金计划(20JR5RA132) |
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| The clinical application of ultrasound in the localization of congenital anorectal malformation in different positions. |
| YUE Zhicheng,LI Quanlin,LI Tiangang,XU Xiaoyan,HAN Lu,WANG Yixuan,YANG Lei,MA Bin |
| (Department of Ultrasound,Gansu Provincial Maternity and Child-care Hospital) |
| Abstract: |
| ABSTRACT Objective To evaluate the consistency and accuracy of embracing and supine ultrasound and inverted X-ray in the diagnosis of congenital anorectal malformation (CARM) before operation.Methods There were 122 cases of congenital anorectal malformation were clinically diagnosed divided into low group and middle-high group. The distance from the distal rectal pouch to the perineum ( P-Pe) was measured by embracing position ultrasound, supine ultrasound, and inverted X-ray before operation. Compared the consistencyand analyze the accuracy of the three methods for P-Pe measurement.Results The sensitivity of embracing position ultrasound, supine ultrasound, and inverted X-ray preoperative application were respectively 97.18 %, 91.54 % and 77.64 %. The specificity of three methods were respectively 96.08 %, 96.08 % and 98.04 %. The coincidence rates were respectively 96.72 %, 93.44 % and 86.07 %. Kappa index was respectively 0.933, 0.867 and 0.725. The area under the ROC curve of embracing position ultrasound, supine ultrasound, and inverted X-ray were respectively 0.992, 0.987 and 0.972, and there was a significant difference (P < 0.001 ). The inverted X-ray measurement results of the middle-high position group were higher than that of the operation measurement ( P < 0.05 ). There was no significant difference between the measurement results of embracing position ultrasound and supine ultrasound compared the operation measurement ( P > 0.05 ). By using completely randomized design data variance analysis, the lower-level group have different means of measurement for different methods (F=46.356, P＜0.001). By using the Dunnett test of pairwise comparison between the means of multiple samples, the supine position ultrasound and the inverted position X-ray measurement results were higher than the surgical measurement values in the lower-level position group ( P<0.05), and there was no statistically significant difference between the embracing position ultrasound and the surgical measurement (P>0.05).Conclusion The accuracy and consistency of the three methods for diagnosing CARM are all higher in the middle-high group. But in the lower-level position group, the ultrasound diagnosis is superior to the inverted X-ray. So, embracing position ultrasound for P-Pe distance measurement has more accurate and clinical value and provides a strong basis for the selection of surgical methods. |
| Key words: Congenital Anorectal Malformation Embracing Ultrasound Supine Ultrasound Inverted X-Ray |
