湿热下注型肛瘘的MRI评价  

The Application of MR Imaging in the Diagnosis of Anal Fistula Originating from Descended and Stagnated Dampness Plus Heat

作　　者：张莲 周年华[3] 杨浩 张少军 石丽[3] 黄钢[1,2,4] ZHANG Lian;ZHOU Nianhua;YANG Hao;ZHANG Shaojun;SHI Li;HUANG Gang(Shanghai University of Traditional Chinese Medicine;Shanghai Key Laboratory of Molecular Imaging,Shanghai University of Medicine and Health Sciences;Department of Radiology,Jiading Hospital of Traditional Chinese Medicine;Department of Nuclear Medicine,Renji Hospital,Shanghai Jiao Tong University School of Medicine)

机构地区：[1]上海中医药大学 [2]上海健康医学院上海市分子影像学重点实验室 [3]上海市嘉定区中医医院 [4]上海交通大学医学院附属仁济医院核医学科

出　　处：《中国医学计算机成像杂志》2023年第2期173-177,共5页Chinese Computed Medical Imaging

基　　金：国家自然科学基金(82127807);上海市分子影像学重点实验室建设项目(18DZ2260400)~~。

摘　　要：目的:评估术前MRI检查对湿热下注型肛瘘的主瘘管、内口、分支及相关脓肿的诊断准确性。方法:收集311例湿热下注型肛瘘的临床及MRI资料,观察MRI影像上主瘘管的数目及走行、内口的数目及位置、分支的数目及形态,以及相关脓肿等影像学特征,并与手术结果进行严格对照,分析诊断灵敏度,评价分型准确性。结果:(1)311例湿热下注型肛瘘,男性267例,平均年龄(40.00±12.14)岁,女性44例,平均年龄(39.75±10.83)岁,体重指数(BMI)为(25.14±3.83)kg/m^(2),113例有过脓肿切开引流史。(2)311例湿热下注型肛瘘中,单纯性肛瘘195例(62.70%),复杂性肛瘘116例(37.30%),共有主瘘管371个,内口374个,分支82个(马蹄形分支14个,非马蹄形分支68个),脓肿53个,外口370个;MRI显示主瘘管、内口、分支及相关脓肿的灵敏度分别为94.61%、90.37%、93.90%和100%。(3)参考Parks分型,371个主瘘管中,窦4个,黏膜下瘘/括约肌间型205个,经括约肌型150个,括约肌上型11个,括约肌外型1个,MRI诊断分型与手术结果具有较好的一致性,κ=0.82 (95%CI 0.77~0.87)。结论:MRI对湿热下注型肛瘘主瘘管、内口、分支、脓肿及分型的诊断和评价具有重要的作用,可为中西医结合治疗提供重要信息。Purpose:To evaluate the accuracy of preoperative MRI for the evaluation of anal fistula originating from descended and stagnated dampness plus heat.Methods:The clinical data and image findings of 311 patients with anal fistula originating from descended and stagnated dampness plus heat were collected.MRI features included numbers and paths of primary fistula,numbers and locations of internal opening,numbers of secondary extension and abscess,etc.MRI diagnoses were compared with surgical results.Results:(1)There were 267 males with an average age of(40.00±12.14)years and 44 females with an average age of(39.75±10.83)years in our study.The body mass index(BMI)of them was(25.14±3.83)kg/m^(2).One hundred and thirteen of these 311 patients had previously undergone perianal abscess drainage.(2)Of the 311 patients,195(62.70%)were with simple anal fistulas,and 116(37.30%)with complex anal fistulas.There were totally 371 primary fistulas,374 internal openings,82 secondary extensions,370 external openings,and 53 abscesses.The sensitivities of MRI in diagnosis of primary fistula, internal opening, secondary extension and related abscess were 94.61%, 90.37%, 93.90% and 100%,respectively. (3) By referring to Parks classification, of the 371 primary fistulas, 4 were sinuses, 205 submucosalfistulas/intersphincteric fistulas, 150 transsphincteric fistulas, 11 suprasphincteric fistulas, and 1 extrasphinctericfistula. MRI diagnoses were in good agreement with surgical results [κ=0.82 (95%CI 0.77-0.87)].Conclusions: MRIhas a crucial role in the evaluation and detection of anal fistula originating from descended and stagnated dampnessplus heat with primary fistulas, internal openings, secondary extensions, abscesses and classifications. This techniqueprovides important information for integrated traditional Chinese and Western medicine treatment.

关 键 词：磁共振成像 多序列成像 湿热下注型肛瘘 

分 类 号：R445.2[医药卫生—影像医学与核医学]