H2O2造影下直肠腔内超声在肛瘘术前诊断中的应用价值

摘要为探讨H2O2造影下直肠腔内超声在肛瘘术前诊断中的应用价值,将110例肛瘘患者随机分为观察组和对照组,各55例,观察组患者术前于H2O2造影下行直肠腔内超声检查,对照组患者术前行普通盲肠腔内超声检查．观察两组主瘘管、支瘘管及内口的显影情况,将其结果与术中所见进行对比。结果显示。观察组和对照组主瘘管诊断的准确率分别为92．7%（51／55）和90．9％（50／55）,P〉0．05;支瘘管诊断准确率分别为85．4％（35／41）和63．2％（24／38）。P〈0．05;内口诊断的准确率分别为90．4％（47／52）和55．1％（27／49）,P〈0．05。结果表明,H2O2造影下直肠腔内超声呵清晰地对肛瘘主瘘管、吏瘘管、内口显影,在肛瘘的术前诊断中具有较高的应用价值。     

经直肠超声联合高频超声在肛周脓肿和肛瘘诊断中的价值

为探讨经直肠超声联合高频超声（简称联合超声）在肛周脓肿、肛瘘诊断中的价值,回顾术前行联合超声检查的肛周脓肿（72例）和肛瘘（48例）患者资料,将联合超声检查结果与手术结果进行对比分析。结果显示,联合超声诊断肛周脓肿、肛瘘显示内口的敏感度分别为97．2％（70／72）和86．7％（52／60）,阳性预测值分别为100％和94．5％（52／55）;联合超声诊断单纯性、复杂性肛瘘的敏感度分别为90．3％（28／31）和70．6％（12／17）,阳性预测值分别为96．6％（28／29）和92．3％（12／13）。结果表明,联合超声对肛周脓肿的诊断、肛瘘内口及瘘管数目和位置的显示具有很高的临床价值。     

肛管腔内三维超声联合瘘管造影对肛瘘的诊断价值

探讨肛管腔内三维超声联合H2O2瘘管造影对肛瘘患者的诊断价值。60例肛瘘住院手术患者,术前均行肛管腔内三维超声及H2O2瘘管造影检查,以手术结果为准,对照分析两者在肛瘘分类、分型及内口位置的诊断准确率。术后随访1年,记录治愈率及复发情况。结果显示,H2O2瘘管造影对肛瘘临床分类及肛瘘内口判断的诊断准确率高于肛管腔内三维超声(P<0.05);两者对肛瘘Parks分型诊断的准确率均较高(P>0.05)。60例患者均治愈,术后随访1年,2例复发。结果表明,肛管腔内三维超声联合H2O2瘘管造影检查能够对肛瘘进行准确的分型、分类,并进一步提高肛瘘内口定位的准确率,具有较高的诊断价值。     

三维肛管直肠腔内超声诊断肛瘘40例

目的:探讨三维肛管直肠腔内超声在肛瘘诊断中的价值.方法:对40例肛瘘患者行三维肛管直肠腔内超声检查,观察肛瘘内口位置、瘘管主管及支管走行等情况,并与术中探查情况进行对比.结果:40例中肛瘘内口定位正确38例(95%),肛瘘主管定位正确39例(98%),支管定位正确11例(85%).结论:三维肛管直肠腔内超声对肛瘘的诊断具有重要作用,是具有较高应用价值的影像检查手段.     

磁共振成像在复杂性肛瘘诊断中的应用

目的探讨磁共振成像（MRI）在复杂性肛瘘诊断中的应用价值。方法28例临床诊断为复杂性肛瘘的患者，术前进行磁共振相控阵列线圈检查。以手术结果为标准，比较术前指诊和MRI的诊断结果。结果有25例患者诊断为复杂性肛瘘，1例为骶前囊肿合并与直肠相通的瘘道，2例肛瘘伴癌变。25例肛瘘Parks分类显示：经括约肌肛瘘3例，括约肌间肛瘘10例，括约肌外肛瘘5例，括约肌上肛瘘7例；MRI与术前指诊检查结果比较，内口检出符合率为84％比48％；原发主管、支管或脓腔检出准确率为100％比76％、94．7％比57．9％；两种检查方法比较，差异有统计学意义（P〈0．01）。结论应用MRI相控阵列线圈能准确定位复杂性肛瘘的内口、瘘管的走向及其与肛管直肠括约肌复合体之间的复杂关系，对排除肛瘘伴其他肛管直肠周围病变具有确切意义。     

肛管直肠内超声在复杂肛瘘诊断中的价值（附45例报告）

目的探讨肛管直肠内超声在复杂肛瘘的临床应用价值。方法对45例复杂性多分支肛瘘管患者进行肛管直肠内超声检查,并结合术中所见以及术后随访对超声结果的价值进行评价。结果肛管直肠内超声可以清晰显示复杂肛瘘瘘管在肛周组织中的走行,并可协助寻找内口。术中探查证实与术前腔内超声提示窦道走形一致者占97.78%。结论肛管直肠内超声技术对于复杂肛瘘的术前诊断具有重要价值。     

H2O2造影直肠腔内超声对肛瘘诊治的意义

目的：探讨H2O2造影直肠腔内超声对提高肛瘘病灶检出率及降低复发率的意义。方法：将110例肛瘘患者随机分为常规直肠腔内超声组（以下简称常规组）、H2O2造影直肠腔内超声组（以下简称H2O2组）,分别观察常规组和H2O2组主瘘管显影率、支瘘管显影率、内口显影率以及术后复发率。结果：常规组与H2O2组的主瘘管显影率分别为90.9%和92.7%,P＞0.05;支瘘管显影率分别为63.2%和85.4%,P＜0.05;内口显影率分别为49.1%和80%,P＜0.05;术后复发率分别为18.2%和5.5%,P＜0.05。结论：肛瘘患者术前行H2O2造影直肠腔内超声,对于提高肛瘘诊断准确率、微小病灶（支瘘管）检出率及降低术后复发率有重要意义。     

三维肛管直肠腔内超声在肛瘘诊治中的应用

目的 探讨三维肛管直肠腔内超声定位肛瘘内口、显示瘘管走行的价值.方法 2008年11月至2010年1月应用三维肛管直肠腔内超声检查肛瘘患者127例,在三维立体模块中根据声像图特征进行内口定位、瘘管走行追踪.结果 定位内口116例,准确率91.3%(116/127),其中112例患者内口开口于齿线处,4例发现内口于直肠壶腹;127例患者定位主管,准确率100%(127/127),其中经括约肌瘘75例,括约肌间瘘47例,括约肌上瘘2例,括约肌外瘘3例;定位支管37例,准确率100%(37/37).结论 应用三维肛管直肠腔内超声检查肛瘘,能够准确定位内口、显示瘘管走行,能为临床治疗方法的选择提供必要的诊断依据.     

二维和三维腔内超声技术应用于肛瘘诊断的比较研究

目的：评估二维和三维腔内超声技术诊断肛瘘的准确性。方法收集2012年1—12月南京市中医院肛肠科住院接受手术治疗的47例肛瘘患者临床影像资料。以术中探查结果为金标准,对二维和三维两种腔内超声检查的诊断结果进行kappa一致性检验。结果二维和三维腔内超声对瘘管内口的诊断均表现出与术中探查结果较好的一致性（kappa系数0．776比0．636）;三维腔内超声对括约肌间瘘、高位经括约肌瘘和括约肌上瘘的诊断与术中探查结果的一致性均极好,并优于二维超声,kappa系数分别为0．810比0．592,0．863比0．548,1．000比0．672;对于分支瘘管的诊断,三维超声也优于二维超声（kappa系数分别为0．659比0．535）;对于合并脓肿的诊断,三维和二维超声一致性均极好（kappa系数：0．881比0．816）。结论三维腔内超声能清晰显示瘘管与括约肌的关系,尤其对高位、合并分支瘘管的复杂性肛瘘,较二维超声的诊断准确性更高。     

DPTRUS对肛瘘瘘管诊断价值分析

探讨经直肠双平面腔内超声(DPTRUS)诊断肛瘘患者的临床价值。肛瘘患者126例,术前接受DPTRUS检查,分析DPTRUS对主瘘管、分支瘘管、内口、外口检出率与手术中所见的检出率。结果显示,126例肛瘘患者,经手术中检查发现主瘘管156个、分支瘘管78个,内口142个、外口148个;DPTRUS对主瘘管、分支瘘管、内口、外口的检出率分别为83.33%、78.21%、90.14%、4.05%。结果表明,DPTRUS诊断肛瘘患者对其瘘管检出率、内口检出率均较高,对于瘘管走行具有良好的判断价值,但是对外口的检出率较低。     

一期根治术与单纯切开引流术治疗肛周脓肿的疗效对比观察

为比较一期根治术与单纯切开引流术治疗肛周脓肿的临床疗效,回顾2010年5月至2012年7月于我院行一期根治术或单纯切开引流术治疗的162例肛周脓肿患者资料,其中行一期根治术治疗106例（观察组）,行单纯切开引流术治疗56例（对照组）,并对两种术式的治疗效果进行对比分析。结果显示,术后随访1～2年,观察组治愈101例（95．28％）,发生肛瘘5例（4．72％）;对照组治愈19例（33．93％）,发生肛瘘37例（66．07％）。观察组肛瘘发生率明显低于对照组,差异有显著统计学意义,P＜O．01。术后随访和二次手术术中探查发现,观察组术后发生肛瘘主要是由于内口定位不准确所致。结果表明,一期根治术治疗肛周脓肿对防止术后形成肛瘘有较明显的效果,对内口定位清楚的肛周脓肿患者采用一期根治术是比较理想的选择。     

内口接力高位变低位肛瘘术治疗高位复杂性肛瘘临床分析

为探讨内口接力高位变低位肛瘘术在治疗高位复杂性肛瘘方面的临床应用效果,将69例高位复杂性肛瘘患者分为治疗组35例与对照组34例,治疗组患者采用内口接力高位变低位肛瘘术治疗,对照组患者采用传统切开挂线术治疗。结果显示,两组患者在创面大小、瘢痕面积、肛门失禁、肛门畸形等方面治疗组优于对照组,差异均有统计学意义（P〈O．05）。结果表明,与传统治疗方法比较,内口接力高位变低位肛瘘术在治疗高位复杂性肛瘘方面具有较好的临床疗效。     

Pre-operative assessment of anal fistulas using endoanal ultrasound

Objective To study the accuracy of endoanal ultrasound in pre‐operative assessment of cryptoglandular anal fistulas, with respect to the site of the internal opening, type and depth of the fistula tract. Patients and methods A consecutive series of 151 patients with anal sepsis underwent pre‐operative endoanal ultrasound assessment of a suspected anal fistula. Hydrogen peroxide was used to define the tract when there was doubt as to the course of the fistula. All patients subsequently had surgical exploration under anaesthesia, irrespective of findings at sonography. The site of the internal opening, depth and type of fistula were recorded at surgery, and concordance with the ultrasound was assessed. Results One hundred and forty‐five patients were subsequently shown to have a fistula at surgical exploration. Type of fistula: Two thirds were transsphincteric (63%) and one third were inter sphincteric (32%), with a few submucosal, and supra sphincteric fistulas. Ultrasound correctly predicted surgical findings in 82% of patients (124/151). Concordance was highest for transsphincteric fistulas (87%). Internal opening: Accuracy of predicting the site of the internal opening was 93% (140/151). The commonest site for the internal opening was the midline posteriorly (49%), followed by the midline anteriorly (25%), the rest lay laterally. Fistula depth: Ultrasound and surgical assessment of the depth of fistulas was concordant in 120 of 145 patients (83%). Conclusions Endoanal ultrasound has a high accuracy of predicting the site of internal opening of an anal fistula. Endoanal ultrasound is able to assess the type and depth of a fistula. This information is useful for pre‐operative planning of fistula treatment.     

切除缝合内口加隧道式拖线术治疗蹄铁型肛瘘的临床研究

为探讨切除缝合内口加隧道式拖线术治疗蹄铁型肛瘘的临床疗效,将80例患者随机分为治疗组和对照组各40例,以治愈时间和术后并发症为主要观察指标。结果显示,治疗组平均治愈时间为（21±3．5）d,术后平均疼痛时间为（5．2土3．2）d;对照组分别为（38±3．7）d和（10．5±4．6）d。两组差异均有统计学意义（P〈O．05）。治疗组均未出现明显肛门畸形、肛门失禁等后遗症。结果表明,切除缝合内口加隧道式拖线术治疗蹄铁型肛瘘,能缩短疗程,保护肛门括约肌功能和保持肛门皮肤的完整,减轻患者疼痛,提高生活质量。     

Three-dimensional endoanal ultrasound for diagnosis of perianal fistulas: Reliable and objective technique

AIM: To evaluate accuracy of three-dimensional endoanal ultrasound (3D-EAUS) as compared to 2D-EAUS and physical examination (PE) in diagnosis of perianal fistulas and correlate with intraoperative findings.METHODS: A prospective observational consecutive study was performed with patients included over a two years period. All patients were studied and operated on by the Colorectal Unit surgeons. The inclusion criteria were patients over 18, diagnosed with a criptoglandular perianal fistula. The PE, 2D-EAUS and 3D-EAUS was performed preoperatively by the same colorectal surgeon at the outpatient clinic prior to surgery and the fistula anatomy was defined and they were classified in intersphincteric, high or low transsphincteric, suprasphincteric and extrasphincteric. Special attention was paid to the presence of a secondary tract, the location of the internal opening (IO) and the site of external opening. The results of these different examinations were compared to the intraoperative findings. Data regarding location of the IO, primary tract, secondary tract, and the presence of abscesses or cavities was analysed.RESULTS: Seventy patients with a mean age of 47 years (range 21-77), 51 male were included. Low transsphincteric fistulas were the most frequent type found (33, 47.1%) followed by high transsphincteric (24, 34.3%) and intersphincteric fistulas (13, 18.6%). There are no significant differences between the number of IO diagnosed by the different techniques employed and surgery (P > 0.05) and, there is a good concordance between intraoperative findings and the 2D-EAUS (k = 0.67) and 3D-EAUS (k = 0.75) for the diagnosis of the primary tract. The ROC curves for the diagnosis of transsphincteric fistulas show that both ultrasound techniques are adequate for the diagnosis of low transsphincteric fistulas, 3D-EAUS is superior for the diagnosis of high transsphincteric fistulas and PE is weak for the diagnosis of both types.CONCLUSION: 3D-EAUS shows a higher accuracy than 2D-EAUS for assessing height of primary tract in transsphincteric fistulas. Both techniques show a good concordance with intraoperative finding for diagnosis of primary tracts.