Zhou Bingyan, Wang Di, Chen Ke, Niu Yonghua, Jiao Chunlei, Zhu Tianqi, Feng Jiexiong
Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Clinical Center of Hirschsprung's Disease and Allied Disorders, Wuhan, China.
Front Pediatr. 2022 Sep 20;10:979149. doi: 10.3389/fped.2022.979149. eCollection 2022.
Preoperative evaluation of the dysganglionic bowel segment is critical for establishing the optimal resection strategy for Hirschsprung's disease (HSCR), which facilitates patient outcomes.
We set out to determine the utility of the 24-h delayed film of barium retention in predicting the length of dysganglionic bowel segment in HSCR.
A retrospective study of patients with clinically suspicious HSCR who underwent a preoperative 24-h delayed film of barium enema and were surgically treated from January 2015 to December 2019 was conducted.
Two hundred and 58 patients were enrolled in this study. The sensitivity, specificity, positive and negative predictive values (NPVs) of the 24-h delayed film of barium enema to predict the neuropathological segment were 89.1, 91.5, 91.3, and 89.4%, respectively. The Youden index was 80.6%, with a kappa value of 0.806 ( < 0.001). The correlation rate between barium retention level and pathological results was 72.7% (16/22) when aganglionosis was restricted within the mid-distal rectum (short-segment type), increasing to 92.0% (46/50) and 93.5% (174/186) for patients that had aganglionosis extended beyond the mid-distal rectum (classical type) and sigmoid colon (long-segment type), respectively. Lastly, patients younger than 3 months showed a lower correlation rate (72.2%) compared to patients aged 3-12 months (91.0%) and > 12 months (92.6%).
Our investigation of the 24-h delayed film of barium enema performed for patients suspected of having HSCR indicated that the barium retention level remains crucial in predicting dysganglionic bowel segment, which contributes to the decision-making for surgical physicians.
对于先天性巨结肠症（HSCR），术前评估无神经节肠段对于制定最佳切除策略至关重要，这有利于患者预后。
我们旨在确定钡剂潴留24小时延迟片在预测HSCR无神经节肠段长度方面的效用。
对2015年1月至2019年12月期间接受术前钡剂灌肠24小时延迟片检查并接受手术治疗的临床疑似HSCR患者进行回顾性研究。
本研究共纳入258例患者。钡剂灌肠24小时延迟片预测神经病理节段的敏感性、特异性、阳性预测值和阴性预测值分别为89.1%、91.5%、91.3%和89.4%。约登指数为80.6%，kappa值为0.806（<0.001）。当无神经节症局限于直肠中下段（短段型）时，钡剂潴留水平与病理结果的符合率为72.7%（16/22）；对于无神经节症超出直肠中下段（经典型）和乙状结肠（长段型）的患者，符合率分别增至92.0%（46/50）和93.5%（174/186）。最后，3个月以下的患者与3至12个月（91.0%）和大于12个月（92.6%）的患者相比，符合率较低（72.2%）。
我们对疑似HSCR患者进行的钡剂灌肠24小时延迟片研究表明，钡剂潴留水平在预测无神经节肠段方面仍然至关重要，这有助于外科医生做出决策。
