后盆底肛周感染的MRI定位初探  

Localization of perianal infection in posterior pelvic floor

作　　者：朱杏莉 张伯英 郭茂林 彭玲 ZHU Xingli;ZHANG Boying;GUO Maolin;PENG Ling(MRI Room,989th Central Hospital of PLA,Luoyang 471031,P.R.China;Department of Radiology,989th Central Hospital of PLA,Luoyang 471031,P.R.China;Department of Special Ecamination,989th Central Hospital of PLA,Luoyang 471031,P.R.China)

机构地区：[1]中国人民解放军联勤保障部队第九八九医院MRI室,河南洛阳471031 [2]中国人民解放军联勤保障部队第九八九医院放射科,河南洛阳471031 [3]中国人民解放军联勤保障部队第九八九医院特检科,河南洛阳471031

出　　处：《医学影像学杂志》2019年第3期451-454,共4页Journal of Medical Imaging

基　　金：国家自然科学基金资助项目(编号:81271537)

摘　　要：目的基于最新的肛部MRI解剖研究成果,探索一种后盆底肛周感染的新定位系统。方法肛部被分为4区。A区位于肛提肌的内侧和上方;B区位于肛提肌的外侧和下方;C区位于中央间隙(肛门平滑肌和肛门外括约肌之间的脂肪间隙),此处肛提肌尾端变成了一系列腱索,导致A区和B区在C区直接连通;S区为肛管黏膜下间隙。依据脓肿和肛瘘的位置,92例患者被计数和分类。结果 92例患者中共发现93处脓肿和肛瘘病灶,与C区有关的感染灶71处,与C区无关者22处,C区通过肌间隙扩散65处,其中与B区通过肛提肌外侧间隙及肛门外括约肌深部、浅部间肌间隙沟通者60处,占92.3%,C区向上通过肛提肌内侧间隙与A区沟通者5处,占7.7%,C区感染灶通过外括约肌和/或耻骨直肠肌累及B区者14例。结论使用全部肛门肌肉和肛周间隙作为界标,可以为外科医生做出一个更精确的肛周感染的定位,指导制定更合理的治疗方案。Objective To explore a new grading system of perianal infection in posterior pelvic floor based on the newest magnetic resonance imaging(MRI) anatomy of anal region. Methods Anal region was subdivided into 4 areas and 12 zones based on all anal muscles and all perianal spaces. Area A is above the levator ani muscle. Area B is below the levator ani muscle. Area C is located in the center space, where the caudal end of the levator ani muscle becomes a series of tendinous cords, resulting in a group of direct channels linking area A and area B at area C. S is submucosal space.Ninety-two patients were counted and classified depending on the location of perianal abscess or fistula. Results There were 93 foci of infection in 92 patients. Seven-one foci were related to C area, and twenty-two foci were not related to C area. There were 65 foci spreading through spatium intermusculare, of which 60 foci were connecting with area B, 5 foci connecting with area A. There were 14 foci spreading through external anal sphincter and/or puborectalis. Conclusion It can make a precise location of perianal infection for surgeons using all anal muscles and all perianal spaces as the landmarks.

关 键 词：肛周感染 定位 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R657.1[医药卫生—诊断学]