Goodsall规律预测与经直肠双平面腔内超声定位肛瘘内口的价值比较  

Comparison of the value of the Goodsall rule and biplane transrectal ultrasonography in positioning the internal opening of anal fistula

作　　者：李燕[1] 王金萍[1] 王琴[1] LI Yan;Wang Jin-ping;Wang Qin(Department of Ultrasound,The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei Anhui 230000,China)

机构地区：[1]安徽中医药大学第一附属医院超声医学科,安徽合肥230000

出　　处：《蚌埠医学院学报》2022年第7期917-919,955,共4页Journal of Bengbu Medical College

基　　金：高校优秀拔尖人才培育资助项目(gxyq2019035);安徽省临床重点专科建设项目。

摘　　要：目的:评估Goodsall规律预测肛瘘内口、经直肠双平面超声定位肛瘘内口的价值。方法:回顾性分析行手术治疗的肛瘘病人52例(70条肛瘘)临床资料,每例病人术前均根据Goodsall规律预测肛瘘内口,同时行经直肠双平面超声探查内口,并与手术探查结果进行一致性检验比较。结果:Goodsall规律预测与手术符合率87.1%,一致性检验Kappa值为0.657,具有较强一致性(P<0.01)。超声探查内口和手术诊断符合率88.6%,一致性检验Kappa值为0.676,具有较强一致性(P<0.01)。70条肛瘘超声探查结果:浅表皮下瘘12条,括约肌间瘘43条,经括约肌瘘10条,括约肌上瘘2条,马蹄形瘘3条。Goodsall规律对浅表皮下型、括约肌间型肛瘘内口预测与超声探查符合率较高(90.1%),对经括约肌型、马蹄形及括约肌上型肛瘘内口预测符合率不高(46.9%),一致性检验Kappa值为0.486,具有中等一致性(P<0.05)。结论:Goodsall规律预测肛瘘内口与手术或经直肠双平面超声具有高度一致性,具有一定临床价值,尤其对浅表皮下型瘘、括约肌间型瘘预测与超声符合率较高,但在预测外口位于横线前的瘘管及马蹄形型、经括约肌型、括约肌上型瘘内口位置有一定局限性;超声探查及临床治疗中可将Goodsall规律与经直肠双平面超声有效结合,提高诊断及治疗效果。Objective:To evaluate the value of the Goodsall rule in predicting internal opening of anal fistula and the value in locating the internal opening of anal fistula using biplane transrectal ultrasonog raphy.Methods:The clinical data of 52 patients(70 anal fistulas) who underwent surgical treatment were retrospectively analyzed.The internal opening of anal fistula of each patient was predicted according to the Goodsall rule before surgery, and the internal fistula was simultaneously explored by biplane transrectal ultrasonography.Both results were compared with surgical exploration results via a consistency test.Results:The consistency rate of the Goodsall rule and operation diagnosis was 87.1%,and the Kappa value in the consistency test was 0.657,showing strong consistency(P<0.01).The consistency rate of ultrasonic exploration and surgical diagnosis was 88.6%,and the Kappa value in the consistency test was 0.676,showing strong consistency(P<0.01).Results of ultrasonic exploration of 70 anal fistulas were listed as follows: 12 superficial subcutaneous fistulas, 43 intersphincteric fistulas, 10 transsphincteric fistulas, 2 superior sphincteric fistulas and 3 horseshoe fistulas.The Goodsall rule had a high coincidence with ultrasonic exploration for superficial subcutaneous, intersphincteric anal fistulas and ultrasonic probe(90.1%).However, the prediction rate of the Goodsall rule for the internal opening of transsphincter type, horseshoe type, and suprasphincter type was not high(46.9%),and the Kappa value of consistency test was 0.486,showing moderate consistency(P<0.05).Conclusions:The value of the Goodsall rule in predicting the internal opening is highly consistent with surgery or biplane transrectal ultrasonography, showing a certain clinical value, especially for superficial subcutaneous fistula and intersphincteric anal fistulas, whereas there are some limitations in predicting the location of fistulas in front of the transverse line and the internal opening of horseshoe, transsphincter, and suprachincter fi

关 键 词：肛瘘 经直肠双平面超声 Goodsall规律 

分 类 号：R657.1[医药卫生—外科学]