经肛周二维及三维超声联合瘘管造影在合并肛门狭窄的肛瘘患者中的临床应用价值  

Application value of trans-anal two-dimensional and three-dimensional ultrasound combined with fistulography in anal fistula with anal stenosis

作　　者：谢林 胡浩清 费维[1] 张少军[2] XIE Lin;HU Haoqing;FEI Wei;ZHANG Shaojun(Department of Function,Shanghai Jiading District Hospital of Traditional Chinese Medicine,Shanghai 201800,China)

机构地区：[1]上海市嘉定区中医医院功能科,上海201800 [2]上海市嘉定区中医医院肛肠科,上海201800

出　　处：《中国中西医结合影像学杂志》2022年第4期364-369,共6页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：上海市嘉定区自然科学研究课题(JDKW-2020-0019)。

摘　　要：目的:评价经肛周二维及三维超声联合瘘管造影在合并肛门狭窄的肛瘘患者中的临床应用价值。方法:术前对120例合并肛门狭窄的肛瘘患者分别行经肛周二维、三维超声联合瘘管造影检查(经肛周超声联合超声造影检查)和MRI检查;以手术结果为参照标准,比较2种方法诊断肛瘘的准确率,并分析其一致性。结果:与手术结果对照,经肛周超声联合超声造影检查和MRI检查对肛瘘内口、主瘘管、支瘘管、肛瘘类型(单纯性、复杂性)及Park’s分型的诊断符合率分别为87.5%vs.86.7%、96.7%vs.98.3%、80.0%vs.85.0%、90.8%vs.92.5%、85.8%vs.91.7%,差异均无统计学意义(均P>0.05)。2种检查方法除对支瘘管检测的一致性稍差外(K=0.368),对肛瘘内口、主瘘管、肛瘘类型(单纯性或复杂性)及Park’s分型的检测一致性均为中等(K=0.519,0.659,0.455,0.462)。结论:经肛周二维、三维超声联合声诺维瘘管造影检查对合并肛门狭窄肛瘘患者的诊断准确率与MRI检查准确率相当,能够作为因肛门狭窄等不能耐受经直肠腔内超声检查患者的有效替代检查,有重要的临床应用价值。Objective:To evaluate the application value of trans-anal two-dimensional and three-dimensional ultrasound combined with fistulography in anal fistula with anal stenosis.Methods:A total of 120 patients with anal fistula with anal stenosis were examined by trans-anal two-dimensional and three-dimensional ultrasound combined with fistulography and enhanced MRI before surgery.The operation results were taken as the reference standard to compare the accuracy of the two methods in the diagnosis of anal fistula and analyze their consistencies.Results:Compared with the results of surgery,the diagnostic accordance rate of trans-anal ultrasound combined fistulegraphy and MRI in the internal orifice,main fistula,branch fistula,type of anal fistula(simple and complex)and Park’s classification of anal fistula were 87.5%vs.86.7%,96.7%vs.98.3%,80.0%vs.85.0%,90.8%vs.92.5%,85.8%vs.91.7%,respectively,and the differences were not statistically significant(all P>0.05).In addition to the slightly poor consistency in the detection of branch fistula(K=0.368),the consistency of internal fistula,main fistula,anal fistula classification(simple or complex)and Park’s classification of anal fistula reached a medium level(K=0.519,0.659,0.455 and 0.462,respectively).Conclusions:The accuracy of trans-anal two-dimensional and three-dimensional ultrasound combined with fistul ography in the diagnosis of anal fistula with anal stenosis is equivalent to that of MRI.It can be used as an effective alternative examination method for patients with anal stenosis or other reasons who cannot tolerate trans-rectal ultrasonography and has an important clinical application value.

关 键 词：直肠瘘 肛门狭窄 超声检查 磁共振成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R657.16[医药卫生—诊断学]