先天性肛门闭锁的临床与影像特征分析

The analysis of the clinical and imaginge features of congenital anal atresia

目的探讨肛门闭锁的发病机制,临床及影像特征。方法对病历资料完整的49例婴幼儿和3例成人肛门闭锁(合并阴道瘘)的临床资料进行回顾性分析。结果男婴29例,女婴20例,49例均做X线检查,其中高位闭锁18例,中位闭锁10例,低位闭锁21例。X线诊断闭锁类别误诊3例,与手术结果对比符合率为93.9%。其中20例做了B超检查,闭锁类别误诊6例,与手术结果对比符合率为70%。X线及瘘道造影检查合并直肠尿道瘘5例,直肠膀胱瘘9例,直肠阴道瘘13例,直肠会阴瘘4例,直肠舟状窝瘘4例,共35例,各种瘘道患儿占71.4%。B超检查出各种瘘道7例,各种瘘道患儿占35%,X线及瘘道造影与手术符合率及瘘道检出率明显高于B超检查(P<0.05)。影像联合检查同时合并其他畸形22例,占总数的44.9%,均有典型的影像学表现及临床表现。成人型3例,主要表现为腹胀、阴道瘘而就诊,均经X线及CT检查,2例为高位闭锁,1例为中位闭锁,均合并直肠阴道瘘。结论 X线、B超、CT及MRI均能诊断先天性肛门闭锁的类别,X线检查结合瘘道造影符合率明显高于B超。MRI诊断最为准确。

Objective To explore the pathogenesis, clinical diagnosisand image feature of analatresia. Methods 49 infants andthree adult of anal atresia were retrospectively analyzed. Results Baby boys were 29 cases, Baby girlswere 20 cases,49 cases were given X - ray. 18 cases were high closure. The median atresia were 10 cases ,21 cases were low atresia. 3 cases were misdiagnosed by X - ray diagnosis. The coincidence rate was 93.9% with the operatio, There were two easesdone B ultrasound to exceed examination ,6 cases were misdiagnosis. The coincidence rate was 70% with the operatio. 5 cases were merge the rectum urethral fistula, Rectovesical fistula in 7 cases, Reetovaginal fistula in 13 cases, Rectal anovulvar fistula in 4 cases, Gruel rectum fistula in 4 cases. 7 cases were checked by B ultrasound accounting for 35% of the children with anal atresia. X - ray combined with fistula angiography and surgical coincidence rate and fistula was much higher than that of B ultrasonic examination, both significant difference was statistically significant （ P 〈 0.05 ）. Combination of other deformity 22 cases at the same time ,44.9% of the total has the influence of typical radiological findings and clini- cal manifestations. Through the X - ray and CT examination, two cases of high atresia were the closure, merge the vagina fistula. Conclusion X - ray, ultrasound, CT, and MRI can diagnose the disease. The surgical coincidence rates of X - ray and fistula angiography examination weresignifieantly higher than that of B ultrasonic. MRI is the most accurate.