CAJ | 학술논문

目的对先天性巨结肠类缘病(Hirschsprung alied disease,HAD)和先天性巨结肠病(Hirschsprung disease,HD)的X线影像表现进行对照研究,探讨二者的影像鉴别要点,为临床诊断提供帮助.方法回顾性分析2004年12月至2009年12月期间经手术及病理证实为HAD病例19例,随机数字表法选取同期经证实的HD病例19例作为对照组.统计痉挛段、截断征、痉挛切迹的出现率及直肠/结肠比值(正位片上测量直肠与结肠的最宽径的比值),观察排钡1 h后残存钡剂的位置.对痉挛段、截断征、痉挛切迹出现率的比较采用x2检验或Fisher精确检验,对直肠/结肠比值的比较采用t检验.结果 HAD组痉挛段出现率为9/19,HD组为18/19,差异有统计学意义(x2=10.364,P＜0.01).HAD组截断征出现率为4/19,HD组为1/19;HAD组痉挛切迹出现率为3/19,HD组为1/19,差异均无统计学意义(P值均＞0.05).HAD组和HD组的直肠/结肠比值分别为0.42±0.15和0.29±0.12,差异有统计学意义(t=2.892,P＜0.01).HAD组中,患儿排钡1 h后钡剂存留于乙状结肠远端者1例,降结肠远端者7例,横结肠远端者1例,全结肠内充满钡剂者6例,4例无残留;HD组中,存留于直肠远端者3例,乙状结肠远端者13例,存留于降结肠远端者3例.结论 HAD组患儿出现痉挛段较HD组少,前者直肠/结肠比值较后者大,有助于二者鉴别;HAD组患儿排钡后1h钡剂残留部位大多数位于降结肠远端,而HD组患儿大多数则位于乙状结肠远端,也可作为鉴别诊断的辅助指标.
목적 대선천성거결장류연병(Hirschsprung alied disease,HAD)화선천성거결장병(Hirschsprung disease,HD)적X선영상표현진행대조연구,탐토이자적영상감별요점,위림상진단제공방조.방법 회고성분석2004년12월지2009년12월기간경수술급병리증실위HAD병례19례,수궤수자표법선취동기경증실적HD병례19례작위대조조.통계경련단、절단정、경련절적적출현솔급직장/결장비치(정위편상측량직장여결장적최관경적비치),관찰배패1 h후잔존패제적위치.대경련단、절단정、경련절적출현솔적비교채용x2검험혹Fisher정학검험,대직장/결장비치적비교채용t검험.결과 HAD조경련단출현솔위9/19,HD조위18/19,차이유통계학의의(x2=10.364,P＜0.01).HAD조절단정출현솔위4/19,HD조위1/19;HAD조경련절적출현솔위3/19,HD조위1/19,차이균무통계학의의(P치균＞0.05).HAD조화HD조적직장/결장비치분별위0.42±0.15화0.29±0.12,차이유통계학의의(t=2.892,P＜0.01).HAD조중,환인배패1 h후패제존류우을상결장원단자1례,강결장원단자7례,횡결장원단자1례,전결장내충만패제자6례,4례무잔류;HD조중,존류우직장원단자3례,을상결장원단자13례,존류우강결장원단자3례.결론 HAD조환인출현경련단교HD조소,전자직장/결장비치교후자대,유조우이자감별;HAD조환인배패후1h패제잔류부위대다수위우강결장원단,이HD조환인대다수칙위우을상결장원단,야가작위감별진단적보조지표.
Objective To compare the X-ray features between Hirschsprung alied disease (HAD)and Hirschsprung disease ( HD), and analyze the differentiations. Methods From December 2004 to December 2009, nineteen cases of HAD, aged from 30 days to 10 years (median, 14 months), received barium enema examinations in our institution. Other 19 cases with HD, also received barium enema examinations, were chosen randomly. They were aged from 42 days to 8 years ( median, 8 months). The imaging features of HAD and HD were analyzed retrospectively. The incidence rate of colon stenosis,"truncation sign" and spasm notch and R/C ratio (the longest diameter of rectum/colon) were calculated and compared between these two groups. In all these cases, diagnosis was confirmed by postoperative histopathology. The position of barium retained was also evaluated. These parameters of both groups were compared by x2 and Fisher test. Results There was statistical significance in the incidence rate of colon stenosis between HAD (9/19) and HD (18/19) (x2 = 10.364, P ＜0.01). However, there was no statistical significance in "truncation sign" and spasm notch between HAD (4/19 and 3/19, respectively)and HD ( 1/19 and 1/19, respectively) (P ＞0. 05 for both). R/C ratio was 0. 42 ±0. 15 in HAD group and 0.29±0. 12 in HD group, and there was statistical significance between them (t =2.892,P＜0.01). In HAD group, barium retained in distal sigmoid colon in 1 case (1/19), in distal descending colon in 7 cases (7/19), in distal transverse colon in 1 case (1/19), in total colon in 6 cases (6/19); However, in HD group, barium retained in distal rectum in 3 cases (3/19), in distal sigmoid colon in 13 cases ( 13/19), in distal descending colon in 3 cases (3/19). Conclusions There were some differences in the imaging features between HAD and HD though they presented similar clinic experience. HAD cases presented a lower incidence rate of colon stenosis and a higher R/C ratio than HD cases. In HAD cases, the most common site of barium retained is distal descending colon, while in HD cases, it is distal sigmoid colon.