دانلود مقاله تشخیص بیماری هیرشپرونگ با سونوگرافی هیدروکلونیک
چکیده
مقدمه
مواد و روش ها
نتایج
نتایج بالینی
بحث
اعلامیه ها
منابع
Abstract
Introduction
Materials and methods
Results
Clinical outcomes
Discussion
Declarations
References
چکیده
اهداف
مقایسه سونوگرافی هیدروکلونیک با هیستوپاتولوژی برای تشخیص کودکان با علائمی که به شدت حاکی از بیماری هیرشپرونگ (HD) هستند.
مواد و روش ها
در این مطالعه آینده‌نگر، بیمارانی که یبوست مقاوم به درمان را نشان می‌دهند، تحت سونوگرافی هیدروکلونیک با تزریق رتروگراد سالین به کولون قرار گرفتند. بخش های متسع، بخش های باریک، نسبت قطر مجرا، منطقه انتقال (TZ)، ضخیم شدن، و پرفیوژن خون روده بالادست مورد بررسی قرار گرفت. حساسیت و ویژگی پارامترهای ترکیبی و منفرد در مقایسه با بیوپسی تعیین شد.
نتایج
صد و سه کودک در این مطالعه وارد شدند. 49 مورد تایید شد که HD دارند. نسبت قطر مجرا نسبت به سایر پارامترها برتری نشان داد. سطح زیر منحنی (AUC) 0.969 (95% فاصله اطمینان [CI]: 0.936-1.000) و مقدار برش 1.51 با تجزیه و تحلیل منحنی مشخصه عملکرد گیرنده (ROC) نسبت قطر مجرا (حساسیت: 89.8٪) ایجاد شد. ؛ ویژگی: 96.3٪. با ترکیب نسبت قطر مجرا به عنوان معیار اصلی با دو معیار جزئی، سونوگرافی هیدروکلونیک حساسیت یکسان (91.8%) و ویژگی بهتر (96.3% در مقابل 87%) را نسبت به تنقیه حاجب نشان داد، اما این تفاوت از نظر آماری معنی دار نبود (0.063= p ). تجزیه و تحلیل سازگاری مقدار کاپا 0.825 (p < 0.001) را نشان داد که نشان دهنده توافق عالی بین سونوگرافی هیدروکلونیک و انما حاجب است.
نتیجه گیری
سونوگرافي هيدروكولونيك يك ابزار تشخيصي با ارزش با حساسيت و ويژگي بالا براي تشخيص HD است كه امكان ارزيابي مورفولوژيكي و عروقي روده بزرگ را فراهم مي‌كند و به خوبي با تنقيه حاجب همبستگي دارد. در شرایط مناسب، سونوگرافی هیدروکلونیک ممکن است یک روش غربالگری جایگزین برای HD در گروه بزرگی از کودکان مبتلا به یبوست باشد.
نکات کلیدی
• سونوگرافي هيدروكولونيك يك ابزار تشخيصي ساده و قابل تحمل با حساسيت و ويژگي بالا براي تشخيص HD است.
• سونوگرافی هیدروکلونیک امکان ارزیابی مورفولوژیکی و عروقی روده بزرگ را فراهم می کند و به خوبی با تنقیه حاجب ارتباط دارد.
• سونوگرافي هيدروكولونيك يك روش جايگزين احتمالي براي بيماران كودكان است كه به شدت پيشنهاد HD هستند.
توجه! این متن ترجمه ماشینی بوده و توسط مترجمین ای ترجمه، ترجمه نشده است.
Abstract
Objectives
To compare hydrocolonic sonography with histopathology for diagnosing children with symptoms highly suggestive of Hirschsprung disease (HD).
Methods
In this prospective study, patients presenting refractory constipation highly suggestive of HD underwent hydrocolonic sonography with retrograde infusion of saline into the colon. The dilated segments, narrowed segments, luminal diameter ratio, transition zone (TZ), thickening, and blood perfusion of the upstream bowel were evaluated. The sensitivity and specificity of combined and single parameters were determined in comparison with biopsy.
Results
One hundred and three children were included in this study; 49 were confirmed to have HD. The luminal diameter ratio showed superiority over other parameters. An area under the curve (AUC) of 0.969 (95% confidence interval [CI]: 0.936–1.000) and a cutoff value of 1.51 were established by receiver operating characteristic (ROC) curve analysis of the luminal diameter ratio (sensitivity: 89.8%; specificity: 96.3%). By combining the luminal diameter ratio as the major criterion with two minor criteria, hydrocolonic sonography showed the same sensitivity (91.8%) and better specificity (96.3% vs 87%) than contrast enema, but this difference was not statistically significant (p = 0.063). Consistency analysis showed a kappa value of 0.825 (p < 0.001), indicating excellent agreement between hydrocolonic sonography and contrast enema.
Conclusions
Hydrocolonic sonography is a valuable diagnostic tool with both high sensitivity and specificity for HD diagnosis, allowing morphological and vascular assessments of the colon, and correlates well with contrast enema. In the appropriate setting, hydrocolonic sonography may be an alternative screening method for HD in a large group of children with constipation.
Introduction
Hirschsprung disease (HD) is a common congenital disorder with a global incidence of approximately 1 in 5000 in newborns [1–4]. HD is characterised by an absence of ganglion cells of the submucosa and myenteric nerve plexus in the distal bowel (usually localised to the rectosigmoid region), which causes the afected bowel to lose its peristaltic ability and leads to dilation of the upstream colon, resulting in refractory constipation. HD is classifed according to the length of the aganglionic section into short-segment (confned to the rectosigmoid region), long-segment (extending beyond the rectosigmoid region), total colonic (entire colon and terminal ileum), and total intestinal (most of the intestines are involved) HD [5]. An operation is recommended once the diagnosis has been established [6].
The diagnosis is based on symptoms, contrast enema, rectal suction biopsy, and full-thickness rectal biopsy. Contrast enema is the imaging modality of choice for HD, with sensitivity ranging from 76 to 88.9% and specifcity from 84.2 to 98% [7–9]. With regard to contrast enema, patients are exposed to radiation; therefore, parents may have safety concerns. Rectal biopsy, despite being radiation-free, is invasive, sometimes requires anaesthesia, and is not widely accepted by parents. Over 80% of patients who undergo biopsies have normal ganglionic biopsies [10, 11]. In our centre, the negative biopsy rate is 74%. Therefore, there is a clear need for a noninvasive, safe, and highly sensitive diagnostic method to increase the positive rate of rectal biopsy. Ultrasound (US), although noninvasive and radiation-free, has limitations for the evaluation of HD: difuse intraluminal gas precludes the detailed evaluation of the colon wall. Second, the rectosigmoid region is the most commonly involved region in HD, and identifcation of this region by trans-abdominal US is challenging due to its deep location.
Results
Patient’s characteristics
Between February 2019 and May 2020, 139 consecutive children met the inclusion criteria; however, 33 patients were subsequently excluded for contrast enema performed at another hospital, 2 were excluded because of fnal diagnoses of post-necrotising enterocolitis stenosis, and 1 was excluded for a fnal diagnosis of the Currarino syndrome. The fnal analysis was performed on 103 patients (median age, 6 months; interquartile range, 3–20 months). There were 41 (39.8%) girls and 62 (60.2%) boys.
According to the rectal biopsy, the absence of ganglion cells was found in 49 patients. In 4 of these, no abnormal fndings of HD were observed on contrast enema (two of them had abnormal hydrocolonic sonography); therefore, a repeat biopsy was subsequently performed, with aganglionosis confrmed in all 4 cases. Thus, 49 patients were diagnosed with HD (43 cases were short-segment disease and 6 were long-segment disease) and 54 cases were ruled out (Fig. 4). There was no signifcant diference regarding age in the HD and non-HD groups (Mann–Whitney test; U=276.000; p=0.756). The HD group had a greater proportion of males (73.5% vs 48.1%, p=0.009).