直肠肛管测压对新生儿先天性巨结肠诊断意义的研究

目的探讨直肠肛管测压对新生儿先天性巨结肠(HD)的诊断价值。方法对我院2003年1月～2005年6月收治的75例临床拟诊为HD的新生儿进行直肠肛管测压,并与钡剂灌肠检查结果及病理结果进行比较。结果75例临床疑诊为HD的新生儿中,经直肠全层病理活检52例,其中48例直肠肛管测压提示HD;2例病理活检正常,其中1例直肠肛管测压未见异常,另1例直肠肛管测压提示HD;2例病理活检诊断为HD,而直肠肛管测压未见异常。本组直肠肛管测压诊断新生儿先天性巨结肠阳性率为92.3%,假阳性率为1.9%,阴性率为1.9%,假阴性率为3.8%。结论新生儿期直肠肛管测压诊断HD,方法简单、安全、无损伤,诊断特异性高。

Preliminary evaluation of clinical value for an orectal manometry for diagnosis of Hirschsprung''''s disease in neonates

Objective To appraise the clinical value of anorectal manometry (ARMM) for diagnosis of Hirschsprung's disease(HD)in neonate. Methods From January 2003 to June 2005,75 suspected HD patients in clinic were analyzed in this study. ARMM was performed using desk high rate gastrointestinal dynamical detection system,and the results were compared with that of barium enema and full-thickness rectal biopsy. Results (1) By full-thichness rectal biopsy in 52 of 75 patients,the positive rate,false positive rate,negative rate and false negative rate of ARMM for diagnosis of HD in neonate were 92.3%,1.9%,1.9% and 3.8%,respectively. (2) 43 of 75 patients showed HD by both ARMM and barium enema,and were also proved by pathological results. 18 clinically suspected HD patients whose results of ARMM and barium enema were normal were excluded HD by follow-up. 12 patients with positive results of ARMM showing HD but negative barium enema were repeatedly performed ARMM,of which 4 patients whose rectoanal inhibitory reflex (RAIR) was elicited were excluded HD,the other 8 patients whose results of ARMM still showing HD were diagnosed as HD by review of barium enema examination and pathological results. 1 of 2 patients with positive barium enema showing HD but ARMM showing RAIR present was excluded HD by pathological results,the other was lost follow-up. The diagnostic accuracy of ARMM and barium enema for HD in neonate were 94.7% and 86.7%,respectively. (3) There was no difference in rectal resting pressure and anal rhythmic wave frequency between HD neonates and normal neonates,but HD neonates were evidently higher than normal neonates in anal sphincter pressure (P=0.0074). Conclusions ARMM is a simple,safe,non-invasive and high-specificity method for diagnosis of HD in neonate.