高频超声诊断新生儿先天性肛门闭锁的临床应用价值

目的探讨高频超声诊断新生儿先天性肛门闭锁的临床应用价值。方法选取2016年1月至2020年5月于本院就诊的新生儿先天性肛门闭锁患儿80例作为研究对象,所有患儿均行高频超声检查及X线检查,以手术结果为金标准分析高频超声检查和X线检查在新生儿先天性肛门闭锁不同分型诊断中的价值。结果经手术证实80例新生儿先天性肛门闭锁患儿中低位肛门闭锁30例,高位肛门闭锁50例;高频超声检查的准确性为91.25%(73/80)、灵敏度为90.00%(27/30)、特异度为92.00%(46/50)、阳性预测值为87.10%(27/31)、阴性预测值为93.88%(46/49)均高于X线检查[73.75%(59/80)、66.67%(20/30)、78.00%(39/50)、64.52%(20/31)、78.00%(39/49)],差异有统计学意义(P<0.05);经Kappa一致性度量,高频超声诊断新生儿先天性肛门闭锁不同分型的结果和手术结果一致性较好(Kappa=0.815,P=0.000);X线诊断新生儿先天性肛门闭锁不同分型的结果和手术结果的一致性一般(Kappa=0.444,P=0.000)。ROC曲线显示,高频超声与X线诊断新生儿先天性肛门闭锁不同分型的AUC分别为0.910(95%CI:0.834~0.986)、0.723(95%CI:0.604~0.843)。结论与X线诊断检查相比,高频超声用于新生儿先天性肛门闭锁不同分型的诊断价值较为显著,能获得较好的诊断准确性、灵敏度、特异性、阳性预测值及阴性预测值,并且与手术结果的一致性较高,临床应用价值较高。

Clinical application value of high frequency ultrasound in the diagnosis of neonatal congenital anal atresia

Objective To explore the clinical application value of high frequency ultrasound in the diagnosis of neonatal congenital anal atresia.Methods 80 cases of patients with neonatal congenital anal atresia admitted to our hospital from January 2016 to May 2020 were selected as the research subjects,all patients underwent high frequency ultrasound and X-ray examination,the surgical results were taken as the gold standard to analyze the value of high frequency ultrasound and X-ray examination in the diagnosis of different types of neonatal congenital anal atresia.Results Among 80 cases of children with neonatal congenital anal atresia confirmed by operation,30 cases were low anal atresia and 50 cases were high anal atresia;the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of high frequency ultrasound examination were 91.25%(73/80),90.00%(27/30),92.00%(46/50),87.10%(27/31)and 93.88%(46/49),respectively,which were higher than those of X-ray examination[73.75%(59/80),66.67%(20/30),78.00%(39/50),64.52%(20/31),78.00%(39/49)],the difference was statistically significant(P<0.05);by Kappa consistency measure,the results of different types of congenital anal atresia diagnosed by high frequency ultrasound were consistent with the results of operation(Kappa=0.815,P=0.000);the results of X-ray diagnosis of different types of neonatal congenital anal atresia were generally consistent with the results of operation(Kappa=0.444,P=0.000).ROC curve showed that AUC of high frequency ultrasound and X-ray in the diagnosis of different types of neonatal congenital anal atresia were 0.910(95%CI:0.834-0.986)and 0.723(95%CI:0.604-0.843),respectively.Conclusion Compared with X-ray examination,high frequency ultrasound has more significant value in the diagnosis of different types of neonatal congenital anal atresia,which can get better diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value,and the consistency with the surgical results is higher,and the clinical application value is higher.