腹部平片在预测先天性袋状结肠类型中的作用。
Role of plain abdominal radiographs in predicting type of congenital pouch colon.
机构信息
Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.
出版信息
Pediatr Radiol. 2010 Oct;40(10):1603-8. doi: 10.1007/s00247-010-1786-4. Epub 2010 Aug 6.
BACKGROUND
Congenital pouch colon (CPC) is a rare form of high ano-rectal malformation (ARM) in which part of or the entire colon is replaced by a pouch with a fistula to the genito-urinary tract. According to the Saxena-Mathur classification CPC is divided into five types. Although plain abdominal radiographs are taken in infants with suspicion of CPC to detect large dilatation of the pouch, the determination of the type of CPC is made during surgical exploration. Since large variations in the length of normal colon are present in the various types, management strategy options can be determined only at the time of surgery.
OBJECTIVE
The aim of this study was to review abdominal radiographs of children with congenital pouch colon (CPC) and evaluate their value in determining the type of CPC prior to surgical exploration to assist pre-operative planning.
MATERIALS AND METHODS
Over a 12-year period (1995-2007), CPC was documented in 80 children (52 boys and 28 girls, age range 1 day-9 years, median 2.4 days) and retrospective analysis of plain abdominal radiographs of 77 children at the time of presentation was performed. Radiographic findings were correlated with surgical findings.
RESULTS
Of 77 children, 5 were excluded from the study since the pouch colon was perforated. The direction of the pouch apex was correlated with surgical findings to determine the CPC type (P<0.0001, Fisher exact test). Type 1 (17/18) and type 2 CPC (18/18) were characterized by a single large pouch with the apex positioned in the left hypochondrium. In type 3 CPC (2/2) the pouch apex was directed towards the right hypochondrium. In type 4 CPC the apex of the pouch was directed towards the right hypochondrium (28/33); however in 5 children it was towards the left hypochondrium. In type 5 CPC (n=1) the radiograph was inconclusive.
CONCLUSION
Plain abdominal radiographs have a predictive value in determining the type of CPC and obviating the need for an invertogram.
背景
先天性囊状结肠（CPC）是一种罕见的高位肛门直肠畸形（ARM），部分或全部结肠被一个与生殖泌尿系统相通的囊状结构所取代。根据 Saxena-Mathur 分类法，CPC 可分为五型。虽然怀疑患有 CPC 的婴儿会进行常规腹部平片检查以发现囊状结构的显著扩张，但 CPC 的分型是在手术探查时确定的。由于不同类型的正常结肠长度差异较大，因此只能在手术时确定治疗策略。
目的
本研究旨在回顾性分析先天性囊状结肠（CPC）患儿的腹部平片，评估其在手术探查前对 CPC 分型的诊断价值，以期协助术前规划。
材料和方法
在 12 年期间（1995 年至 2007 年），共记录了 80 例 CPC 患儿（52 例男孩和 28 例女孩，年龄 1 天至 9 岁，中位数为 2.4 天），对其中 77 例患儿的首次就诊时的腹部平片进行回顾性分析。对影像学表现与手术发现进行相关性分析。
结果
由于 5 例患儿的囊状结肠穿孔，因此排除在本研究之外。通过分析囊状结构的尖端方向与手术发现的相关性来确定 CPC 分型（P<0.0001，Fisher 确切概率法）。1 型（17/18）和 2 型 CPC（18/18）的特征为单一较大的囊状结构，尖端位于左季肋区。3 型 CPC（2/2）的囊状结构尖端指向右季肋区。4 型 CPC 中，囊状结构尖端指向右季肋区（28/33），但有 5 例指向左季肋区。5 型 CPC（n=1）的腹部平片表现不具特征性。
结论
腹部平片在确定 CPC 分型方面具有预测价值，可以避免进行静脉肾盂造影检查。
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