直肠肛管测压术前辅助诊断小儿先天性巨结肠的价值分析

Value analysis of anorectal manometry in preoperative diagnosis of Hirschsprung’s disease in children

目的探讨直肠肛管测压术前辅助诊断小儿先天性巨结肠(HD)的价值。方法疑似HD的87例患儿,以直肠全层活检或术后病理检查为金标准,评估术前直肠肛管测压术前辅助诊断HD的价值,并与X线钡灌肠检测结果进行比较。结果87例患儿接受直肠全层活检或术后病理检查,其中58例确诊为HD。直肠肛管测压与金标准的一致性Kappa值为0.867。X线钡灌肠检查与金标准的一致性Kappa值为0.651。直肠肛管测压的准确率、灵敏性和阴性预测值分别为94.25%(82/87)、98.28%(57/58)、96.15%(25/26),均高于X线钡灌肠检查的82.76%(72/87)、75.86%(44/58)、66.67%(28/42),差异有统计学意义(P<0.05);直肠肛管测压的特异性和阳性预测值分别为86.21%(25/29)、93.44%(57/61),与X线钡灌肠检查的96.55%(28/29)、97.78%(44/45)比较,差异无统计学意义(P>0.05)。直肠肛管测压与X线钡灌肠检查HD的一致性Kappa值为0.534。直肠肛管测压诊断HD的受试者工作特征曲线(ROC)曲线下面积为0.922,大于X线钡灌肠检查的0.836,但差异无统计学意义(P>0.05)。结论直肠肛管测压术前辅助诊断HD,具有操作简单、安全性高、诊断灵敏性高的特点。

Objective To discuss the value of anorectal manometry in preoperative diagnosis of Hirschsprung's disease(HD)in children.Methods For 87 children with suspected HD,full-thickness rectal biopsy or postoperative pathological examination was used as the gold standard to evaluate the value of preoperative anorectal manometry in the auxiliary diagnosis of HD,and to compare with the results of X-ray barium enema.Results 87 children underwent full-thickness rectal biopsy or postoperative pathological examination,and 58 of them were diagnosed with HD.The consistency Kappa of anorectal manometry and gold standard was 0.867.The consistency Kappa of X-ray barium enema and gold standard was 0.651.The accuracy,sensitivity and negative predictive value of anorectal manometry were 94.25%(82/87),98.28%(57/58),and 96.15%(25/26),which were higher than 82.76%(72/87),75.86%(44/58),and 66.67%(28/42)of X-ray barium enema,and the difference was statistically significant(P<0.05).The specificity and positive predictive value of anorectal manometry were 86.21%(25/29)and 97.78%(57/61),which were not statistically significant from 96.55%(28/29)and 93.44%(44/45)of X-ray barium enema(P>0.05).The consistency Kappa value of anorectal manometry and X-ray barium enema detection of HD was 0.534.The area under receiver operating characteristic(ROC)curve of HD detected by anorectal manometry was 0.922,which was larger than 0.836 detected by X-ray barium enema,but the difference was not statistically significant(P>0.05).Conclusion Anorectal manometry is simple,safe and sensitive in preoperative diagnosis of HD.