经直肠腔内三维超声诊断肛瘘的临床价值研究(1)
【摘要】 目的：探讨经直肠腔内三维超声在肛瘘术前诊断中的临床价值。方法：选取2016年
1月-2017年8月本院收治的肛瘘患者53例，按检查方式不同分为三维超声组(EAUS组)30例和二维超声组(TRUS组)23例，分别在术前接受不同的检查，在检查后5 d内进行手术治疗。以手术结果作为最终标准，对比两组的术前诊断结果。结果：53例患者经手术后证实均存在肛瘘内口，EAUS组术前诊断正确率为93.3%，明显高于TRUS组的56.5%(P<0.05)；在不同分型瘘道诊断中，EAUS组对括约肌间型、经括约肌型、括约肌外型及括约肌上型的术前诊断正确率均高于TRUS组，但比较差异均无统计学意义(P>0.05)；手术证实53例患者存在支瘘者34例，EAUS组术前诊断正确率为89.5%，明显高于TRUS组的53.3%(P<0.05)。结论：EAUS所独有的三维立体成像技术对于肛瘘诊断具有独特优势，对于肛瘘内口、肛瘘支瘘的诊断效果均优于TRUS，可作为肛瘘术前检查的有效的诊断技术在临床进行推广。
【关键词】 经直肠腔内三维超声； EAUS； 肛瘘； 临床价值
【Abstract】 Objective：To investigate the clinical value of transrectal three-dimensional ultrasound in preoperative diagnosis of anal fistula.Method：53 cases of anal fistula admitted in our hospital from January 2016 to August 2017 were selected，according to different examination methods，they were divided into 30 cases of three-dimensional ultrasound group(EAUS group) and 23 cases of two-dimensional ultrasound group(TRUS group)，underwent different examinations before surgery，and underwent surgical treatment within 5 days after the examination.The final outcome was surgical outcome，and the results of preoperative diagnosis of two groups were compared.Result：53 patients were proved to have anal fistula after surgery，the accuracy rate of preoperative diagnosis of EAUS group was 93.3%，which was significantly higher than TRUS group of 56.5%(P<0.05).In the diagnosis of different types of fistula，the accuracy of preoperative diagnosis of sphincter type，sphincter type，sphincter shape and sphincter type of EAUS group were higher than those of TRUS group，the differences were not statistically significant(P<0.05).34 patients were proved to have branch fistula after surgery，the accuracy rate of preoperative diagnosis of EAUS group was 89.5%，which was significantly higher than 53.3% of TRUS group(P<0.05).Conclusion：The unique three-dimensional imaging technique of EAUS has unique advantages in diagnosis of anal fistula，the diagnosis of anal fistula and branch fistula are better than those of TRUS，can be used as an effective diagnostic technique for preoperative anal fistula examination and is popularized in clinical practice.
【Key words】 Transrectal three-dimensional ultrasound； EAUS； Anal fistula； Clinical value
First-author’s address：Jiangmen Wuyi Hospital of Traditional Chinese Medicine，Jiangmen 529000，China
doi：10.3969/j.issn.1674-4985.2017.34.012
肛瘺是指直肠肛管与肛门周围皮肤之间的感染性通道，外口位于肛周皮肤，内口位于肛管齿状线，内外口之间形成由纤维组织构成的肉芽组织管腔[1]。肛瘘约占肛肠疾病的25%，仅次于痔，多见于青壮年，男性多于女性[2]。目前一致认为手术是治疗肛瘘最有效的方法[3]。但由于肛瘘所涉及到的结构较复杂，导致手术治疗复发率较高。内口的术前诊断不准确、对瘘管走形及其与肛周括约肌的关系不明确、术中或术后处理不当都是造成术后复发的常见原因[4-5]。因此，肛瘘手术前的检查与诊断尤为重要。准确的术前检查有助于提高肛瘘手术成功率，降低复发率，减轻患者的生理与经济负担[6]。目前肛瘘的术前检查方法有多种，各有优势与劣处。瘘管造影对肉芽组织充填或粘连的瘘管显影效果不佳，无法对此类患者的肛瘘走形及支瘘与肛周括约肌间的关系作出明确判断[7-8]。多层螺旋CT成像技术能清晰地显示内口位置、其与肛管括约肌间的关系，但对于瘘管与括约肌复合体及盆底肌肉间的关系难于判断，此外，对于瘘管不畅的肛瘘亦无法做出明确诊断[9]。MRI对于软组织的分辨率较高，成像范围较大，可明确肛瘘与肛周括约肌的关系、肛提肌上方的病变部位等，但价格昂贵，且耗时较长。肛管直肠内二维超声简单易行且价格低廉，在多数医院均可开展，但其无法显示瘘管长度以及走形全态。相对于二维超声，三维超声是将连续不同平面的二维图像进行计算机处理，最终获得一个重建的有立体感的图形[10]。在肛瘘的术前检查中，可对肛瘘内口位置、瘘管走形及其与肛周括约肌的关系作出准确的判断，为手术治疗提供可靠依据[11]。本研究以49例肛瘘患者为例，对经直肠腔内三维超声在疾病诊断中的价值进行了分析与讨论，现报道如下。, http://www.100md.com(梁英级 吴静 邓玉莲 黄淑卿 林玉涓 余剑波)
1月-2017年8月本院收治的肛瘘患者53例，按检查方式不同分为三维超声组(EAUS组)30例和二维超声组(TRUS组)23例，分别在术前接受不同的检查，在检查后5 d内进行手术治疗。以手术结果作为最终标准，对比两组的术前诊断结果。结果：53例患者经手术后证实均存在肛瘘内口，EAUS组术前诊断正确率为93.3%，明显高于TRUS组的56.5%(P<0.05)；在不同分型瘘道诊断中，EAUS组对括约肌间型、经括约肌型、括约肌外型及括约肌上型的术前诊断正确率均高于TRUS组，但比较差异均无统计学意义(P>0.05)；手术证实53例患者存在支瘘者34例，EAUS组术前诊断正确率为89.5%，明显高于TRUS组的53.3%(P<0.05)。结论：EAUS所独有的三维立体成像技术对于肛瘘诊断具有独特优势，对于肛瘘内口、肛瘘支瘘的诊断效果均优于TRUS，可作为肛瘘术前检查的有效的诊断技术在临床进行推广。
【关键词】 经直肠腔内三维超声； EAUS； 肛瘘； 临床价值
【Abstract】 Objective：To investigate the clinical value of transrectal three-dimensional ultrasound in preoperative diagnosis of anal fistula.Method：53 cases of anal fistula admitted in our hospital from January 2016 to August 2017 were selected，according to different examination methods，they were divided into 30 cases of three-dimensional ultrasound group(EAUS group) and 23 cases of two-dimensional ultrasound group(TRUS group)，underwent different examinations before surgery，and underwent surgical treatment within 5 days after the examination.The final outcome was surgical outcome，and the results of preoperative diagnosis of two groups were compared.Result：53 patients were proved to have anal fistula after surgery，the accuracy rate of preoperative diagnosis of EAUS group was 93.3%，which was significantly higher than TRUS group of 56.5%(P<0.05).In the diagnosis of different types of fistula，the accuracy of preoperative diagnosis of sphincter type，sphincter type，sphincter shape and sphincter type of EAUS group were higher than those of TRUS group，the differences were not statistically significant(P<0.05).34 patients were proved to have branch fistula after surgery，the accuracy rate of preoperative diagnosis of EAUS group was 89.5%，which was significantly higher than 53.3% of TRUS group(P<0.05).Conclusion：The unique three-dimensional imaging technique of EAUS has unique advantages in diagnosis of anal fistula，the diagnosis of anal fistula and branch fistula are better than those of TRUS，can be used as an effective diagnostic technique for preoperative anal fistula examination and is popularized in clinical practice.
【Key words】 Transrectal three-dimensional ultrasound； EAUS； Anal fistula； Clinical value
First-author’s address：Jiangmen Wuyi Hospital of Traditional Chinese Medicine，Jiangmen 529000，China
doi：10.3969/j.issn.1674-4985.2017.34.012
肛瘺是指直肠肛管与肛门周围皮肤之间的感染性通道，外口位于肛周皮肤，内口位于肛管齿状线，内外口之间形成由纤维组织构成的肉芽组织管腔[1]。肛瘘约占肛肠疾病的25%，仅次于痔，多见于青壮年，男性多于女性[2]。目前一致认为手术是治疗肛瘘最有效的方法[3]。但由于肛瘘所涉及到的结构较复杂，导致手术治疗复发率较高。内口的术前诊断不准确、对瘘管走形及其与肛周括约肌的关系不明确、术中或术后处理不当都是造成术后复发的常见原因[4-5]。因此，肛瘘手术前的检查与诊断尤为重要。准确的术前检查有助于提高肛瘘手术成功率，降低复发率，减轻患者的生理与经济负担[6]。目前肛瘘的术前检查方法有多种，各有优势与劣处。瘘管造影对肉芽组织充填或粘连的瘘管显影效果不佳，无法对此类患者的肛瘘走形及支瘘与肛周括约肌间的关系作出明确判断[7-8]。多层螺旋CT成像技术能清晰地显示内口位置、其与肛管括约肌间的关系，但对于瘘管与括约肌复合体及盆底肌肉间的关系难于判断，此外，对于瘘管不畅的肛瘘亦无法做出明确诊断[9]。MRI对于软组织的分辨率较高，成像范围较大，可明确肛瘘与肛周括约肌的关系、肛提肌上方的病变部位等，但价格昂贵，且耗时较长。肛管直肠内二维超声简单易行且价格低廉，在多数医院均可开展，但其无法显示瘘管长度以及走形全态。相对于二维超声，三维超声是将连续不同平面的二维图像进行计算机处理，最终获得一个重建的有立体感的图形[10]。在肛瘘的术前检查中，可对肛瘘内口位置、瘘管走形及其与肛周括约肌的关系作出准确的判断，为手术治疗提供可靠依据[11]。本研究以49例肛瘘患者为例，对经直肠腔内三维超声在疾病诊断中的价值进行了分析与讨论，现报道如下。, http://www.100md.com(梁英级 吴静 邓玉莲 黄淑卿 林玉涓 余剑波)