经直肠内超声在肛瘘诊断中的应用价值  

The diagnostic value of transrectal ultrasound in anal fistula

作　　者：刘敏 崔蕾 程莉莉 方建强 朱文峰 Liu Min Cui Lei Cheng Lili Fang Jianqiang Zhu Wenfeng.(Department of Ultrasound Diagnosis, Central Hospital of Xianyang, Xi- anyang, Shaanxi, 712000, China)

机构地区：[1]咸阳市中心医院超声诊断科,陕西咸阳712000

出　　处：《结直肠肛门外科》2017年第4期529-532,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的观察经直肠腔内超声在肛瘘诊断中的应用价值。方法选取本院2012年8月至2014年10月收治的62例肛瘘住院患者为例,应用彩色多普勒超声诊断仪进行诊断,经皮探查肛瘘病变部位及主、支瘘管分布走行,观察病变周围血流信号;经直肠探查深部瘘管的数目、走行。观察肛瘘外口距肛门距离、数目、走行,内口距肛门距离、象限、水平,肛瘘主、支瘘管情况。总结经直肠腔内超声的图像特征,以术中探查结果为基准计算内口定位、肛瘘分类及瘘管的诊断符合率,绘制ROC曲线模型观察经直肠腔内超声诊断肛瘘分型的敏感度、特异度,与术中探查结果进行对照。结果肛瘘内口呈低回声,形状为圆形或不规则;主瘘管为内外口之间较粗长者,走行可直可迂曲。内口定位诊断符合率为95.16%(59/62),肛瘘分类诊断符合率为95.16%(59/62),主瘘管诊断符合率为98.39%(61/62),分支瘘管诊断符合率为86.96%(40/46),超声诊断括约肌间肛瘘敏感度93.9%,特异度93.1%;超声诊断经括约肌肛瘘敏感度96%,特异度97.3%;超声诊断括约肌上肛瘘、括约肌外瘘管敏感度及特异度均100%。结论经直肠腔内超声对于肛瘘内口位置、瘘管走行及瘘管分型的诊断符合率较高,可为手术方案的制定提供丰富的影像学依据。Objective To observe the diagnostic value of transrectal ultrasound in anal fistula. Methods A total of 62 patients with anal fistula in our hospital from August 2012 to October 2014 were selected. All of the patients were diagnozed by color Doppler ultrasonography, and were additionlly The lesions of anal fistula, and the distribution of the primary and secondary fistula,as well as the blood flow signal around the fistula were detected by percutaneous exploration. The external opening（distance to anal, number and fistulous tracts）, the,locate internal opening（distance to anal, quadrant, level）, and the main fistula and branch were observed. The image features of transrectal ultrasound was summarized. In additon,the accuracy of transrectal ultrasound in calculating the location of internal opening and the classification were compared with a reference standard derived from surgical findings. ROC curve was used to observe the sensitivity and specificity of transrectal ultrasound in the diagnosis of anal fistula. Results The inner port is hypoechoic, with circular or irregular shape. The primary fistula was thicker, which located between the inside and outside the inner port, and the fistulous tracts were either straight or not. The accuracy rate of inner port positioning,anal fistula classification, the primary fistula, and the fistula was 95.16%（59/62）, 95.16%（59/62）,and 98.39%（61/62）, 86.96%（40/46） respectively. The sensitivity of ultrasound diagnosis for intersphincteric fistula was 93.9%, and the specificity was 93.1%, which for transsphincteric fistula they were 96%, and 97.3%, respectively. Ultrasound diagnosis on extrasphincteric fistula, the sensitivity and the specificity of anal sphincter were both 100%. Conclusion Ultrasonography in the diagnosis of anal fistula can accurately determine the location of the inner port, fistula and fistula classification,and it can be a good surgical option in providing a full range of imaging basis.

关 键 词：肛瘘 经直肠腔内超声 内口 瘘管 

分 类 号：R445.1[医药卫生—影像医学与核医学] R574.8[医药卫生—诊断学]