临床小儿外科杂志2025，Vol.24Issue(5)：429-435,7.DOI:10.3760/cma.j.cn101785-202405022-007
先天性肛门直肠畸形伴直肠尿道瘘的早期识别与诊断研究
Early identification and accurate diagnosis in children with anorectal malformation with rectourethral fistula
摘要
Abstract
Objective To estimate the value of meconium passaging after birth and two imaging modali-ties for early identification and accurate diagnosis in children with anorectal malformation(ARM)plus rec-tourethral fistula and provide an optimal selection of surgical approaches.Methods The authors retrospective-ly collected the clinical and imaging information of ARM children fulfilling the inclusion criteria from 2016 to 2023.Among them,99 were confirmed whether or not meconium passaging through urethra before colostomy and 124 underwent invertography and transperineal sonography.They were divided into various groups according to the condition of meconium passaging(meconium passaging group and non-meconium passaging group)or type of pathology(rectoperineal group,rectourethral bulbar group and rectourethral prostatic group).Receiver oper-ating characteristic curve(ROC)analysis was performed for comparing the predictive value between two ima-ging modalities.Results A total of 154 ARM children were enrolled:48(31.2％)with rectoperineal fistula and 106(68.8％)with rectourethral fistula.Eighty-two(82.8％)had no meconium passaging before colosto-my.No statistically significant inter-group differences existed in ARM type,pouch-perineum distance or fistula diameter(P＞0.05).For invertography and transperineal sonography,optimal cutoff values,AUC,sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 20.70 mm,0.658(0.559,0.757),72.4％,58.3％,73.3％,57.1％,66.9％versus 15.25 mm,0.633(0.534,0.731),38.2％,89.5％,85.3％,47.8％,58.1％,respectively.No statistically significant differences existed in AUC or accura-cy between two modalities(P＞0.05).A combination of invertography and transperineal sonography yielded an AUC of 0.672 with 62.9％accuracy,showing no significant improvement over individual modalities(P＞0.05).Conclusions Meconium passaging through urethra before colostomy is rare in ARM children with rec-tourethral fistula.Both invertography and transperineal sonography demonstrate comparable diagnostic efficacy in distinguishing low-type from intermediate/high-type ARM,serving as crucial supplements to physical examina-tion for early identification and colostomic decision-making.关键词
肛门直肠畸形/X线/腔内超声检查/诊断/诊断,鉴别/儿童Key words
Anorectal Malformations/X-Ray/Endosonography/Diagnosis/Diagnosis,Differential/Child引用本文复制引用
肖咸明,向晨翥,冯伟,陈泯名,迭小红,侯金平,王佚..先天性肛门直肠畸形伴直肠尿道瘘的早期识别与诊断研究[J].临床小儿外科杂志,2025,24(5):429-435,7.基金项目
国家儿童健康与疾病临床医学研究中心临床医学研究一般项目(NCRCCHD-2022-GP-03) （NCRCCHD-2022-GP-03）
重庆医科大学未来医学青年创新团队支持计划(W0125) National Clinical Medical Research Center for Children's Health and Disease Clinical Medical Research General Project(NCRCCHD-2022-GP-03) （W0125）
Future Medical Youth Innovation Team Support Program of Chongqing Medical University(W0125) （W0125）
