多层螺旋CT在先天性肛门直肠畸形中的应用价值

The diagnostic value of multi-slice spiral CT on congenital anorectal malformation

目的探讨多层螺旋cT在新生儿先天性肛门直肠畸形中的应用价值。方法搜集2009年1月至2012年6月经手术治疗的先天性肛门直肠畸形患者37例，术前均行腹部倒立侧位x线平片和64排cT扫描，分别测量直肠盲端-肛窝距离，与手术结果作相关性分析。通过cT定量测量耻骨直肠肌（PR）和肛门括约肌（EAS）的宽度及发育指数，以5例正常新生儿的盆底肌测量作对照，比较不同闭锁位置的PR和EAS发育指数的差异性。通过cT三维重建图像观察瘘管、骶尾椎畸形等伴发畸形。结果37例患者中肛门高位闭锁6例，中间位闭锁17例，低位闭锁14例。本组资料显示与腹部倒立侧位平片测量结果相比，cT测量直肠盲端-肛窝距离与手术结果相关性更好（低位：rct=0．874，rDR=0．688；中间位：rct=0．849，rDR=0．348；高位：rct=0．974，rDR=0．960，P〈0．05）。本组显示耻骨直肠肌（PR）和肛门括约肌（EAS）的发育指数在不同闭锁位置中无明显差异（P〉0．05）。本组有14例合并瘘管，cT显示瘘管有5例（显示率为35．7％）。尾椎缺如9例（24．3％），骶椎融合3例（8．1％）。结论多层螺旋cT可以准确显示先天性肛门直肠畸形的类型、评价耻骨直肠肌和肛门括约肌的发育状况和了解伴发畸形，对临床手术方式的选择、预后评估提供可靠的影像学依据。

Objective To explore the value of multi-slice spiral CT （MSCT） in assessment of congenital anorectal malformation. Methods The data on 37 neonates with congenital anorectal malformation were retrospectively reviewed. The distance between the end of the rectum and the anal pit was measured both on X-ray plain film and MSCT, and the data was compared with surgical result,which served as the reference standard.Both the width and the development index of puborectalis and sphincterofanus was also calculated. Results MSCT showed a better correlation with Surgical result in differentiation of the imperforate anus.Additionally, no difference of the width and the development index of puborectalis and sphincterofanus was found between different types of inmerforate anus（P〉0.05）. Conclusions MSCT provides a reliable assessment of congenital anorectal malformation.