肛瘘磁共振成像分型  

Classification of anal fistulas based on magnetic resonance imaging

作　　者：刘得超 李文儒[1] 王馨华[1] 邱建平[1] 王玲 熊斐[1] 周智洋[1] Liu Dechao;Li Wenru;Wang Xinhua;Qiu Jianping;Wang Ling;Xiong Fei;Zhou Zhiyang(Department of Radiology,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院放射科,广州510655

出　　处：《中华胃肠外科杂志》2018年第12期1391-1395,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家重点研发计划(88000-41110007);广州市科技计划项目(201704030082).

摘　　要：目的探讨肛管磁共振(MRI)检查对肛瘘分型的诊断价值。方法回顾性分析中山大学附属第六医院2010年3月至2015年9月连续收治的行MRI检查的2160例肛瘘患者的肛管MRI资料。排除有外院手术史的患者232例、合并克罗恩病218例、合并直肠癌6例以及合并其他疾病8例后,共1696例肛腺隐窝感染性肛瘘患者被纳入本研究。所有患者均接受MRI增强扫描检查,先通过躯体中线进行矢状位快速自旋回波T2加权像(FSE T2WI)成像,然后在矢状位图像上设定冠状及轴位的扫描定位线,冠状位扫描线平行于肛管的长轴,轴位垂直于肛管的长轴。根据肛瘘的位置及走行,以Parks分型为主、结合我们团队临床经验,将肛瘘依括约肌间型、经括约肌型、括约肌上型、括约肌外型及表浅型进行分型,并采用截石位时钟法描述内口分布情况。结果1696例肛腺隐窝感染性肛瘘患者中,男1456例,女240例,中位年龄为26.5(0.2~87.0)岁,其中<20岁的患者占8.4%(143/1696),20~40岁的患者占57.4%(973/1696),40-60岁的患者占28.4%(482/1696),>60岁的患者占5.8%(98/1696)。全组患者共接受0.5T扫描568次,1.5T扫描1128次。高位肛瘘492例(29.0%),低位肛瘘1204例(71.0%)。MRI分型结果如下:括约肌间型1057例(62.3%),经括约肌型407例(24.0%),括约肌上型68例(4.0%),括约肌外型54例(3.2%),表浅型67例(4.0%),还有43例(2.5%)肛瘘难以分型。MRI共发现内口1996个,其中952(47.7%)个内口位于截石位5~7点方向。结论MRI检查能准确地对肛瘘进行分型并明确内口位置,可为临床治疗和手术提供可靠的影像学依据。Objective To explore the diagnostic value of magnetic resonance imaging (MRI) in anal fistula. Methods A total of 2160 patients were clinically diagnosed with anal fistula at the Sixth Affiliated Hospital of Sun Yat-sen University from March 2010 to September 2015. Among them, 232 cases with operative history at other hospital, 218 with Crohn′s disease, 6 with rectum cancer and 8 with other disease were excluded, and 1696 patients were finally enrolled and retrospectively analyzed. The saggital FSE T2WI imaging was confirmed based on the midline of body, and then the coronal and axial scanning line were confirmed. The key point was that the coronal scanning line must parallel and the axial scanning line must be perpendicular to the major axis of anal canal. The characteristics of anal fistula were recorded, and anal fistula were classified as five types, including intersphincteric, transphincteric, suprasphincteric, extrasphincteric and superficial fistula according to the Parks classification and our experience. The distribution of internal opening was described by using lithotomy position clock method. Results Of 1696 patients, 1456 were males and 240 females with median age of 26.5 (0.2 to 87.0) years. Age of 8.4%(143/1696) cases was under 20 years old, of 57.4%(973/1696) cases was between 20 to 40, of 28.4%(482/1696) cases was between 40 to 60, of 5.8%(98/1696) cases was over 60. The 1696 MR examinations included 1128 on 1.5T MR and 568 on 0.5T MR. Of all the anal fistulas was 29.0%(492) high position and 71.0%(1204) was low position.Among the 1696 patients, 1057 were intersphincteric fistulas (62.3%), 407 were transphincteric fistulas(24.0%), 68 were suprasphincteric fistulas (4.0%), 54 were extrasphincteric fistulas (3.2%), 67 were superficial fistulas (4.0%), and 43 (2.5%) were difficult to classify. A total of 1996 internal openings were found and most of them were located around the dentate line of 5-7 o′clock in lithotomy position (47.7%, 952/1996). Conclusions Anal fistula mainly occur in young men

关 键 词：肛瘘 磁共振成像 分型 内口 回顾性分析 

分 类 号：R657.16[医药卫生—外科学] R445.2[医药卫生—临床医学]