BOLALAR ANUS ATREZIYASIDA PRON-LATERAL RENTGENOGRAFIYA VA TRANSPERINEAL ULTRASONOGRAFIYA: REKTO-PERINEAL MASOFANI ANIQLASHDA MUQOBIL YONDASHUV
Abstrakt
So‘nggi paytlarda anorekatal malformatsiyalarni (ARM) tashxislashda ultratovush sonografiya usulidan foydalanish to‘g‘risidagi ba’zi ma’lumotlar mavjud, ammo ushbu texnika haqida tadqiqot natijalari keng yoritilgan ilmiy ishlar kam uchraydi.
Tadqiqot maqsadi. Chaqaloqlarda exografik sonografiya orqali anus atreziyasi turini aniqlash samaradorligini va uning klinik amaliyotdagi qo‘llanish imkoniyatlarini baholashdan iborat.
Tadqiqot materiali va usullari. Tadqiqot ishida anus atreziyasi mavgud 27 ta chaqaloqlarda rektal qopcha va teri orasidagi masofani aniqlashga qaratilgan rentgenologik vizualizatsiya va ultrasonografik usullarning diagnostik sezuvchanligi va aniqligi jihatidan taqqoslama taxlil o‘tkazildi. Barcha chaqaloqlarda invertografiya va pron-lateral holda rentgenografiya, shuningdek transperineal exosonografiya o‘tkazildi.
Tadqiqot natijalari va uning muxokamasi. Natijalarga ko‘ra rivojlanish nuqsonlari tarkibida hazm trakti tug‘ma nuqsonlari bilan yotqizilgan bemorlar xissasi ko‘pchilikni tashkil qilgan. Jami 27 nafar bemorlardan 4 ta xolatda oqmaning mavjudligi va 3 ta xolatda kloaka rivojlanish nuqsoni borligi tadqiqotga jalb qilishga istisno bo‘ldi va bu chaqaloqlar tadqiqotdan chiqarib tashlandi. Qolgan 20 ta bolalardan ARM ning quyi turi 13 tasida, yuqori va oraliq turlari 7 tada, mos ravishda 3 va 4 ta bolalarda uchradi. Tanlab olingan bemor bolalarda pron-lateral holatdagi rentgenografiya va perineal sonografiya usulining anus atreziyasini tashxislashdagi maxsusligi va sezuvchanligi, shuningdek miqdoriy testlarning axborotlilik darajasini baholash uchun ROC-taxlil amalga oshirildi. Exosonografiya uchun AUC (Area Under Curve) qiymati yuqori (0,92) bo‘lib, bu uning anus atreziyasini tashxislashdagi sezuvchanligi yuqori ekanini ko‘rsatadi, ya’ni exosonografiya 92% holatlarda to‘g‘ri tashxis qo‘yish imkoniyatini beradi. Pron-lateral rentgenografiyaning AUC qiymati pastroq (0,58) bo‘lib, bu uning sezuvchanlik va aniqlik darajasi exosonografiyaga nisbatan past ekanligini ko‘rsatadi. Exosonografiyada sezuvchanlik 92,3% ni tashkil qildi, bu esa tashxislash ehtimolining yuqori darajada sezuvchanligini ko‘rsatadi. Shuningdek, maxsusligi 85,7% bo‘lib, bu ham uning tashxisda yuqori samaradorlikka ega ekanini anglatadi. Rentgenografiyada esa sezuvchanlik 15,4% ni tashkil etdi, bu esa uning aniqlash darajasi pastligini ko‘rsatadi, biroq maxsuslik darajasi 100% bo‘lib, faqat aniq holatlarda tasdiqlandi.
Xulosa. Anorektal tug‘ma nuqsonlarni erta tashxislashda transperineal exosonografiyani darhol o‘tkazish mumkinligi anomaliyalarning anatomik xususiyatlari real vaqtda aniqlash va baholash, jarrohlik rejasini to‘g‘ri belgilash imkonini yaratadi. Shuningdek, bu usul nurlanish xavfini keltirib chiqarmasligi uni rentgenografiyaga nisbatan afzal usulga aylantiradi.
Mualliflar haqida
Adabiyotlar ro'yxati
Pavlov S. V. Anorektalnыe malformatsii: sovremennыe podxodы k lecheniyu. Kazanskiy meditsinskiy jurnal. 2020;101(5):111-116.
Sharipov M. A. Bolalarda anorektal nuqsonlar: klinik tashxis va davolash usullari. O’zbekiston tibbiyot jurnali. 2017;29(3):75-80.
Smith AG, Leye RB, et al. Recent advances in congenital anorectal malformations. Pediatr Surg Int. 2018;34(6):345-352.
Wang S, Zhang Y, et al. Diagnostic imaging of low-type imperforate anus in neonates. J Ultrasound Med. 2020;39(2):265-271.
Leye KH, Cho HJ, et al. Multi-modal assessment in newborns with anorectal malformations. Radiol Pediatr. 2019;48(4):214-221.
Zare P, Broumand B, et al. Anorectal malformations and associated anomaliyes in neonates. Iran J Radiol. 2017;14(2):190-196.
Dobbs T, Gosain A. The role of imaging in neonatal imperforate anus management. Pediatr Radiol. 2021;51(8):974-980.
Hernandez S, Mullins J. Clinical assessment and management in anorectal malformations. Clin Pediatr Surg. 2019;28(1):23-30.
Gant TD, Meiyer MA. Advances in the surgical approach to anorectal malformations. J Pediatr Surg. 2019;54(5):1020-1028.
Garcia JD, Scott A. Congenital anorectal malformations: a reviyew of current treatments. Clin Neonatol. 2022;55(1):5-12.
Haskins A, Subramaniam S. Outcomes of early surgical intervention for low-type imperforate anus. Surg Neonatol. 2016;38(3):209-215.
Johns L, Freyeman K, et al. Imperforate anus in neonates and VACTERL association. Pediatr Radiol. 2020;50(11):1307-1315.
Lane N, Roberts K, et al. MRI applications in the diagnosis of anorectal malformations. Pediatr Imaging. 2018;19(6):433-440.
Marsh W, Patton T. Postoperative care and management of imperforate anus. J Pediatr Surg. 2020;55(7):1452-1460.
Larson CJ, et al. Current concepts in the reconstruction of congenital anorectal malformations. Ann Pediatr Surg. 2022;30(2):101-115.
Grayson JM, et al. Imaging considerations for neonates with anorectal malformations. Radiol Clin North Am. 2019;57(5):1127-1142.
Mitchell LR, Hernandez SL. Sonographic assessment in the diagnosis of neonatal anorectal malformations. Ultrasound Med. 2021;40(5):963-968.
Brown S, Lucas EA. Advancements in neonatal anorectal malformation imaging. J Pediatr Surg. 2017;52(9):1351-1359.
Chang KY, et al. Clinical applications of MRI in diagnosing neonatal imperforate anus. Clin Pediatr Surg. 2016;28(6):344-350.
Simmons HJ, et al. Diagnostic efficiyency of prone cross-table radiography for low-type imperforate anus. Pediatr Radiol. 2019;49(7):816-822.
Holschneider A., Hutson J., Peña A., Beket E., Chatterjeye S., Coran A. et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J. Pediatr. Surg. 2005; 40: 1521-1526.
Hosokawa T, Yamada Y, Sato Y, Tanami Y, Tanaka Y, Kawashima H, Oguma E. Changes in the Distance Betweyen the Distal Rectal Pouch and Perineum From the Birth Day to the Next Day in Neonates With an Imperforate Anus. J Ultrasound Med. 2017 Mar;36(3):601-606. doi: 10.7863/ultra.16.04042. Epub 2017 Jan 27. PMID: 28127784.