摘要目的：探讨结肠传输试验（CTT）联合肛门直肠测压（ARM）、钡灌肠（BE）及排粪造影（DFG）检查在慢传输型便秘合并成人巨结肠术前结肠病变范围精准评估的应用价值。方法回顾性分析2007年10月至2015年2月期间湖南省人民医院收治的47例慢传输型便秘合并成人巨结肠手术患者的病例资料，全组患者均行≥2次CTT联合ARM和BE检查，42例同时行DFG检查，对患者术前结肠病变范围进行评估。并以术中病理检查为标准，计算术前联合检查对定位盲肠升结肠、横结肠及降结肠慢传输的灵敏度、特异度、阳性预测值及阴性预测值，然后，进行一致性Kappa检验（Kappa值≥0．75为一致性好，且Kappa值越大一致性程度越高）。术后6个月采用Heikkinen评分评价患者排粪功能。结果全组47例患者年龄18～56岁。 CTT联合BE、DFG定位慢传输结肠段在盲肠升结肠12例、横结肠26例、降结肠9例；术中所见及快速病理检查示慢传输结肠段在盲肠升结肠11例、横结肠23例、降结肠13例。42例（89．4％）术前联合检查定位慢传输结肠段与术中所见及快速病理检查的结果符合，灵敏度为88．3％，特异度为93．5％，阳性预测值为92．1％，阴性预测值为94．9％，一致性检验Kappa值＝0．827（P ＜0．001）。手术治疗行结肠部分切除8例，结肠次全切除29例，结肠全切除10例。无术中及术后严重并发症的发生。术后6个月进行Heikkinen评分示，24例（60．0％）患者术后排粪功能为“优”，10例（25．0％）为“良”，6例（15．0％）为“一般”，无评分“差”的患者。术后随访1～7（中位数3）年，40例（85．1％）患者获得随访，术后均无长期腹泻及便秘、巨结肠复发。结论术前对慢传输型便秘合并成人巨结肠患者进行CTT联合ARM、BE及DFG检测，能够预先对结肠病变范围进行较为精准的评估，具有较好的临床预测价值。

abstractsObjective To investigate the application value of colonic transit test (CTT) combined with anorectal manometry (ARM), barium enema (BE) and defecography (DFG) in accurately evaluating colonic lesions of slow transit constipation complicated with adult megacolon. Methods Clinical data of 47 above patients admitted between October 2007 and February 2015 in the People′s Hospital of Hunan Province were analyzed retrospectively. All the patients were examined with≥2 times of CTT combined with ARM and BE, and 42 cases received additional DFG at the same time, to evaluate colonic lesions before operation. Operative biopsy pathology was used as the standard. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of positioning in the ascending colon and caecum , transverse colon and descending colon were calculated ,and the consistency was represented by Kappa test (Kappa value≥0.75 indicates good consistency, meanwhile higher Kappa value indicates better consistency). The Heikkinen score was used to evaluate defecation function at postoperative 6 months. Results The age of 47 patients was from 18 to 56 years old. Compared with intraoperative findings and biopsy pathology, the diagnostic coincidence rate was 89.4% by CTT combined with BE and DFG positioning, which suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=12), transverse colon (n=26) and descending colon (n = 9), while intraoperative findings and biopsy pathology suggested pathology-changed colonic segment locating in the ascending colon and cecum (n = 11), transverse colon (n =23) and descending colon (n=13). The sensitivity was 88.3%, specificity 93.5%, PPV 92.1%, NPV 94.9% and Kappa value was 0.827 (P < 0.001). Procedures performed included segmental colectomy (n=8), subtotal colectomy (n=29), total colectomy (n = 10). There was no serious complication during and after operation. Defecatory function was excellent in 24 cases (60.0%), good in 10 (25.0%), and moderate in 6 (15.0%) evaluated by Heikkinen score at postoperative 6 months. A total of 40 patients were followed up from 1 to 7 years (median 3 years) and there was no long-term diarrhea and recurrence of constipation or giant colon after operation. Conclusion Preoperative detection of CTT combined with ARM, BE and DFG in patients with slow transit constipation complicated with adult megacolon can make a more precise assessment of the extent of colonic lesions in advance, which has a good clinical predictive value.