会阴部残留窦道MRI检查影像学特征  

Magnetic resonance imaging features of persistent perineal sinus

作　　者：乔立超 周寄文 章俊彪 孙桂东[1] 竺平[1] 邵万金[1] 杨柏霖[1] Qiao Lichao;Zhou fiwen;Zhang Junbiao;Sun Guidong;Zhu Ping;Shao Wanjin;Yang Bolin(Department of Anorectal Surgery,Affiliated Hospital,Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China Corresponding author ： Yang Bolin,Email ： blyang1971@ 163.com)

机构地区：[1]南京中医药大学附属医院肛肠科,210029

出　　处：《中华消化外科杂志》2018年第9期959-963,共5页Chinese Journal of Digestive Surgery

基　　金：江苏高校优势学科建设工程资助项目（035062002003）;江苏省“十二五”中医药重点学科（jsl301）

摘　　要：目的总结会阴部残留窦道（PPS）的MRI检查影像学特征。方法采用回顾性描述性研究方法。收集2010年7月至2017年1月南京中医药大学附属医院收治的7例PPS患者的临床资料。患者均为直肠癌经腹会阴联合切除术后。患者行MRI检查横轴位、矢状位和冠状位扫描．由两名副主任医师以上级别医师共同阅片，若诊断意见不统一，则协商后统一结果。观察指标：（1）MRI检查影像学特征。（2）治疗和随访情况。患者完成MRI检查后，根据MRl检查表现行窦道切除术，术后行常规病理学检查。采用电话方式进行随访，了解患者窦道复发和再次手术情况。随访时间截至2017年4月。结果（1）MRI检查影像学特征。①病灶位置：7例患者PPS病灶均位于骶前部位，头侧端最高达第三骶椎平面，向下延伸至会阴部。②形态及信号：7例患者窦道表现为不规则片状或管状异常信号：纤维化窦道壁T1加权成像（T1WI）和T2加权成像（T2WI）均呈低信号；窦道内容物T1WI为低信号，T2WI及T2加权成像-脂肪抑制（T2WI-FS）为高信号；7例患者中2例PPS信号均匀，5例信号混杂。③分支及囊腔：1例患者窦道在尾骨尖处出现分支，延伸至骶尾椎后方。4例患者窦道顶端膨大形成囊腔。④感染征象：3例患者窦道周围脂肪间隙模糊、渗出，与盆腔器官分界不清晰，部分粘连；1例患者伴见盆底肌肉增厚肿胀，T2WI-FS为高信号；2例患者见窦道后方片状积液，T2WI-FS为高信号，提示骶前组织水肿。⑤强化特征：1例患者行MRI增强扫描示窦道轻度均匀强化。（2）治疗和随访情况：7例患者均行窦道切除术，其中2例因位置较高无法全部切除，头侧部分窦道予以充分搔刮；5例顺利施行手术。患者术后常规抗感染治疗。创面愈合时间为14~78d，平均愈合时间为42d。术后病理学检查均可见不同程度的炎细胞浸润。7�Objective To summarize the magnetic resonance imaging （MRI） features of the persistent perineal sinus （PPS）. Methods The retrospective and descriptive study was conducted. The clinical data of 7 patients with PPS who were admitted to the Nanjing University of Traditional Chinese Medicine between July 2010 and January 2017 were collected. Patients received horizontal, anteroposterior axes and coronal scanning of MRI after abdominoperineal resection （APR） of rectal cancer. Two physicians read collectively films and then achieved consistent results if there was a disputed result. Observation indicators： （ 1 ） MRI features; （2） treatment and follow-up situations. Patients underwent resection of PPS according to results of MRI examination, and then regular pathological examination. Follow-up using telephone interview was performed to detect sinus recurrence and reoperation up to April 2017. Results （1） MRI features： ① Lesion location： lesions of PPS in 7 patients were located at the presacral areas, top side was up to the third sacral plane, and lower side extended down to the pubic area. ② Morphology and signal： sinus tract of 7 patients showed irregular flaky and tubular abnormal signals; fibrotic sinus tract wall showed low signals in T1 weighted imaging （T1WI） and T2WI; contents of sinus tract in 7 patients showed low signal in T1WI and high signals in T2WI and T2WI-fat suppression （T2WI-FS）.Of 7 patients, uniform signal and mixed signal were respectively detected in 2 and 5 patients. ③ Branches and cystic spaces： 1 patient had a branch at the tip of the coccyx, extending to the rear of the sacral vertebra. The top of sinus tract in 4 patients enlarged to form a cavity. ④ Signs of infection ： signs of infection in 3 patients included blurred and exuded fat gaps around the sinus tract, unclear and partially adhesion with pelvic organ; the pelvic floor muscles in 1 patient were thickened and swollen, with a high signal in T2WI-FS; flaky fluid shadows in 2 patients

关 键 词：会阴部残留窦道 磁共振成像 影像学检查 窦道切除术 

分 类 号：R711[医药卫生—妇产科学] R445.2[医药卫生—临床医学]