Xiao Xianming,Xiang Chenzhu,Feng Wei,et al.Early identification and accurate diagnosis in children with anorectal malformation with rectourethral fistula[J].Journal of Clinical Pediatric Surgery,2025,(05):429-435.[doi:10.3760/cma.j.cn101785-202405022-007]
先天性肛门直肠畸形伴直肠尿道瘘的早期识别与诊断研究
- Title:
- Early identification and accurate diagnosis in children with anorectal malformation with rectourethral fistula
- Keywords:
- Anorectal Malformations; X-Ray; Endosonography; Diagnosis; Diagnosis; Differential; Child
- 摘要:
- 目的 探讨生后胎粪排出情况与倒立位X线、经会阴超声对先天性肛门直肠畸形(anorectal malformation,ARM)伴直肠尿道瘘患儿早期识别和准确诊断的价值,为手术方案选择提供参考。方法 回顾性分析重庆医科大学附属儿童医院2016年1月至2023年12月收治的154例男性ARM患儿临床和影像学资料。其中99例可明确结肠造瘘术前胎粪是否经尿道排出,根据胎粪是否排出将99例患儿分为胎粪排出组(n=17)和无胎粪排出组(n=82);124例可明确接受过倒立位X线和经会阴超声检查,根据病理类型将124例患儿分为会阴瘘组(n=48),尿道球部瘘组(n=42),以及前列腺部瘘组(n=34)。采用受试者操作特征(receiver operating characteristic,ROC)曲线比较倒立位X线、经会阴超声对ARM伴直肠尿道瘘的预测效能。结果 154例ARM患儿中,直肠会阴瘘48例(31.2%)、直肠尿道瘘106例(68.8%)。82例在结肠造瘘前无胎粪经尿道排出。胎粪排出组和无胎粪排出组在ARM类型、直肠盲端到肛隐窝距离、瘘管直径的差异无统计学意义(P>0.05)。倒立位X线、经会阴超声预测ARM伴直肠尿道瘘的最佳截断值、ROC曲线下面积(area under the ROC curve,AUC)95%CI、灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为20.70 mm、0.658(0.559,0.757)、72.4%、58.3%、73.3%、57.1%、66.9%;15.25 mm、0.633(0.534,0.731)、38.2%、89.5%、85.3%、47.8%、58.1%。两者AUC、准确率的差异无统计学意义(P>0.05)。采用倒立位X线联合经会阴超声预测ARM伴直肠尿道瘘时,AUC为0.672(0.576,0.768),准确率为62.9%;与单独采用两种方法预测ARM伴直肠尿道瘘相比,AUC、准确率差异均无统计学意义(P>0.05)。结论 直肠尿道瘘患儿行结肠造瘘前,胎粪经瘘管从尿道排出的情况少见。在区分低位与中高位ARM畸形时,倒立位X线与经会阴超声的诊断效能相似,是体格检查后早期诊断直肠尿道瘘及是否结肠造瘘的重要补充。
- Abstract:
- Objective To estimate the value of meconium passaging after birth and two imaging modalities for early identification and accurate diagnosis in children with anorectal malformation (ARM) plus rectourethral fistula and provide an optimal selection of surgical approaches. Methods The authors retrospectively collected the clinical and imaging information of ARM children fulfilling the inclusion criteria from 2016 to 2023.Among them,99 were confirmed whether or not meconium passaging through urethra before colostomy and 124 underwent invertography and transperineal sonography.They were divided into various groups according to the condition of meconium passaging (meconium passaging group and non-meconium passaging group) or type of pathology (rectoperineal group,rectourethral bulbar group and rectourethral prostatic group).Receiver operating characteristic curve (ROC) analysis was performed for comparing the predictive value between two imaging modalities. Results A total of 154 ARM children were enrolled:48(31.2%) with rectoperineal fistula and 106(68.8%) with rectourethral fistula.Eighty-two (82.8%) had no meconium passaging before colostomy.No statistically significant inter-group differences existed in ARM type,pouch-perineum distance or fistula diameter (P>0.05).For invertography and transperineal sonography,optimal cutoff values,AUC,sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 20.70 mm,0.658(0.559,0.757),72.4%,58.3%,73.3%,57.1%,66.9% versus 15.25 mm,0.633(0.534,0.731),38.2%,89.5%,85.3%,47.8%,58.1%,respectively.No statistically significant differences existed in AUC or accuracy between two modalities (P>0.05).A combination of invertography and transperineal sonography yielded an AUC of 0.672 with 62.9% accuracy,showing no significant improvement over individual modalities (P>0.05). Conclusions Meconium passaging through urethra before colostomy is rare in ARM children with rectourethral fistula.Both invertography and transperineal sonography demonstrate comparable diagnostic efficacy in distinguishing low-type from intermediate/high-type ARM,serving as crucial supplements to physical examination for early identification and colostomic decision-making.
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备注/Memo
收稿日期:2024-5-9。
基金项目:国家儿童健康与疾病临床医学研究中心临床医学研究一般项目(NCRCCHD-2022-GP-03); 重庆医科大学未来医学青年创新团队支持计划(W0125)
通讯作者:王佚,Email:wy757311@Hotmail.com