术前三维肛管直肠腔内超声检查对肛瘘的应用价值

目的：探讨三维肛管直肠腔内超声（3D-EAUS）检查在肛瘘术前评估中的应用价值。方法前瞻性纳入2012年3月至2013年3月第二炮兵总医院结直肠肛门外科连续收治的诊断明确、拟行手术的100例肛瘘患者，采用计算机产生随机号的方法随机分为超声组和对照组，每组各50例。超声组术前采用3D-EAUS检查，对照组术前常规检查、采用指诊或探针探查，比较两组肛瘘内口定位、肛瘘分型及是否存在分支瘘管的准确率。结果与对照组比较，超声组的内口定位准确率较高，超声组和对照组分别为96．0％（48／50）和82．0％（41／50）（P＝0．02）。超声组与对照组对复杂性肛瘘的诊断分别为96．7％（29／30）比74．1％（20／27）（P＝0．021）；对肛瘘分型的诊断分别为96．0％（48／50）比78％（39／50）（P＝0．01）；对是否存在分支瘘管的诊断分别为94．0％（47／50）比84．0％（42／50）（P＝0．025）。但对于简单性肛瘘，两组内口定位准确率相当[95．0％（19／20）比91．3％（21／23）， P＝1．000]。结论三维肛管直肠腔内超声在内口定位、瘘管分型及分支瘘管的诊断方面具有较高的应用价值，尤其对复杂性肛瘘患者，值得在临床推广。

Value of three-dimensional endoanal ultrasonography for anal fistula assessment

Objective To explore the value of preoperative evaluation with three-dimensional endoanal ultrasonography （3D-EAUS） for anal fistula in order to provide preoperative assessment for anal fistula. Methods One hundred patients diagnosed with anal fistula undergoing surgery between March 2012 and March 2013 in our department were prospectively enrolled. All the patients were randomly divided into the ultrasound group and the control group with fifty patients in each group. The ultrasound group received 3D-EAUS and the control group received routine examinations （digital examination and probe） to assess the position of the internal opening, the type of fistula and secondary tracks, respectively. The concordance rate of the preoperative assessment and intraoperative exploration was evaluated between the two groups. Results The accuracy of identifying internal opening was 96.0%for the ultrasound group and 82.0% for the control group with statistically significant difference （P=0.02）. The accuracy of identifying internal opening for simple anal fistula was similar （95.0% vs. 91.3%, P=1）. For complex anal fistula, the accuracy was also higher in the ultrasound group （96.7%vs. 74.1%, P=0.025）. The accuracy of fistula classification was 78.0% for the ultrasound group and 96.0% for the control group with significant difference （P=0.01）. The accuracy of identifying a second track was higher in the ultrasound group （96.0% vs. 82.0%, P=0.025）. Conclusions It is significantly superior for 3D-EAUS to detect the internal opening , fistula classification and identification of a second track in complex anal fistulas as compared to conventional examination. 3D-EAUS should be recommended as a preoperative assessment for anal fistula , especially for complex one.