两种影像学检查对中高位先天性肛门直肠畸形的诊断价值研究

Evaluations of two imaging examination in the diagnosis of anorectal malformations

目的探讨经结肠远端加压造影与磁共振检查在先天性肛门直肠畸形(anorectal malformation,ARM)诊断中的应用价值。方法收集重庆医科大学附属儿童医院收治的83例先天性肛门直肠畸形患者二期手术前骶尾部磁共振与经结肠远端加压造影检查结果,明确两种影像学检查在诊断ARM直肠盲端及异常瘘管上的准确性及优点。结果83例患者中,80例磁共振检查结果、经结肠远端加压造影检查结果与临床病理类型一致(Kappa=0.794);3例磁共振检查结果与造影结果相比,前者仅能显示直肠盲端的位置,未显示异常瘘管。83例中,经磁共振成像测得直肠盲端距肛隐窝的距离、经结肠远端加压造影检查测得直肠盲端距肛隐窝距离分别为(36.90±9.14)mm和(36.39±10.81)mm,与术中实际测得距离(34.40±12.70)mm相比,差异均无统计学意义(P>0.05)。83例ARM患者磁共振检查结果显示,合并脊髓栓系8例,终丝脂肪变性5例,骶管内脂肪瘤1例,脊髓圆锥低位5例,骶尾骨发育异常3例,马蹄肾2例,肾脏发育不良3例,输尿管扩张5例,输尿管末端囊肿1例,双子宫畸形2例,Currarino综合征2例。结论两种影像学检查均能明确直肠盲端位置及异常瘘管情况,但磁共振对于伴发畸形的诊断优势明显;相比于造影检查,磁共振具有组织分辨率高、无辐射暴露及肠穿孔风险等优点。

Objective To explore the application value of distal pressure colostogram(DPCG)versus pelvic magnetic resonance imaging(MRI)in the diagnosis of congenital anorectal malformations(ARMs).Methods A retrospective analysis was performed for 83 ARM children before and after second-stage operation to clarify the accuracy and advantages of two imaging modes.Results Among them,80 cases were diagnosed by MRI and clinical pathological type was consistent with the results of DPCG.Three cases showed merely the position of blind rectum and no abnormal fistula was detected.The distances between rectum and anal crypt as measured by MRI,DPCG and actually intraoperatively were(36.90±9.14),(36.39±10.81)and(34.40±12.70)mm respectively.There was no significant difference(P>0.05).MRI revealed tethered spinal cord(n=8),terminal filament steatosis(n=5),intrasacral lipoma(n=1),conical spinal cord hypoplasia(n=5),metatarsal tail dysplasia(n=3)and horseshoe kidneys(n=2),abnormal kidney development(n=3),ureteral dilatation(n=5),ureteral cyst(n=1),double uterine malformation(n=2)and Currarino syndrome(n=2).Conclusion Conclusion Both imaging studies can determine the location of blind rectum and abnormal fistulas.As compared with DPCG,MRI offers obvious diagnostic advantages of higher tissue resolutions,radiation non-exposure and bowel non-perforation.