Reliability of endosonography in evaluation of anal fistulae and abscesses

Objective:
To assess the reliability of anal endosonography (AES) in the diagnosis of anal fistulae and abscesses. Material and Methods:
86 patients with different types of anal fistulae and abscesses were prospectively examined with a 7.0 MHz transducer. Type of anal fistulae, differentiation between simple and complex tracts, and location of their internal openings were defined. In 66 cases with permeable external opening, hydrogen peroxide solution was introduced into the fistula tract. Reliability of AES was defined after surgical treatment of all cases. Results:
74 anal fistulae, including 43 transsphincteric, 11 intersphincteric, 6 suprasphincteric, 3 superficial, and 11 ano-vaginal were found on AES. 27 fistulae were complex, and 47 simple fistulae. In 10 patients a coexisting abscess was found; the remaining 12 abscesses were without any fistula. Surgery confirmed the type of anal fistula in 64 patients (86.5%), and location of internal openings in 60 cases (81.1%). All abscesses were confirmed. Conclusion:
AES showed high accuracy in diagnosing anal fistulae and abscesses.     

Comparison of contrast-enhanced with non-contrast endosonography in the diagnostics of anal fistulas

The objective of this paper is to compare the accuracy of standard, non-contrast endosonography (EAS) with contrast-enhanced endosonography (CE-EAS) in the diagnosis of anal fistulas. The group consisted of 126 patients (mean age: 43.1 years) with the clinical diagnosis of anal fistula. For anal endosonography, a Bruel & Kjaer unit with a 7.0-MHz transducer was used with a 3% solution of hydrogen peroxide as the contrast agent (1, 2, 3). In each case, EAS and CE-EAS diagnoses of the type and complexity of anal fistula, as well as the location of the internal opening, were determined. Results showed that CE-EAS was significantly more accurate in diagnosing the type of anal fistulas than NC-EAS (97 vs. 94%, respectively; P=02275), and in differentiating simple from complex tracks (92 vs. 75%, respectively; P<0.00001). CE-EAS was much more accurate in patients with recurrent fistulas (57 vs. 92%, respectively; P<0.00006), whereas in a subgroup of primary tracks, both methods were of comparable accuracy. Sensitivities of CE-EAS and EAS for internal opening were 89 and 65%, respectively. The conclusion of this paper is that CE-EAS significantly increases the accuracy of standard non-contrast EAS and is especially beneficial for the differentiation between simple and complex tracks.     

磁共振成像对肛瘘分级的价值

目的探讨磁共振成像（MRI）对肛瘘分级价值。方法经手术证实的肛瘘患者26例,全部行MRI检查,检查序列主要包括轴面T1WI、T2WI和轴面、冠状面抑脂T2WI序列。结果 26例肛瘘中,Ⅰ级10例,Ⅱ级6例,Ⅲ级5例,Ⅳ级3例,Ⅴ级2例。MRI诊断26例肛瘘中共有28个瘘管,26个内口,31个外口,14个脓肿,敏感度分别达93%、93%、97%、100%。结论 MRI可以对肛瘘准确分级,对正确的手术治疗非常重要。     

3.0T高分辨率磁共振成像在肛瘘诊断及分型中的应用

目的探讨3.0T高分辨MRI在肛瘘术前诊断及分型的应用价值。方法选取经手术证实的51例肛瘘患者的临床资料及MRI表现,并与手术结果对照分析,总结肛瘘的MRI表现特点及应用价值。结果51例肛瘘手术显示内口56个,外口43个,主瘘管51条、瘘管分支14条,脓肿16个。与手术结果对照,术前MRI显示肛瘘内、外口、主瘘管及支管的准确率分别为94.64%(53/56个)、100%(43/43个)、94.12%(48/51条)及85.71%(12/14条),对脓肿显示的准确率为100%(16/16个)。按照Parks分型,51例患者MRI共检出括约肌间型肛瘘23例(45.10%),经括约肌型肛瘘17例(33.33%),括约肌上型肛瘘7例(13.73%),括约肌外型肛瘘4例(7.84%),MRI分型准确率为96.08%(49/51例)。MRI在肛瘘Parks分型上与手术结果一致性高,差异无统计学意义(P>0.05)。结论MRI能准确显示肛瘘内、外口的位置,瘘管的数量及走行,能够对肛瘘进行准确分型。     

3.0 T MRI在复杂型肛瘘术前诊断中的应用

目的:探讨3.0T MRI在复杂型肛瘘术前诊断中的应用价值。方法:收集21例经手术治疗的复杂型肛瘘患者的临床及影像资料,患者均行MRI平扫及增强扫描,对比手术结果,评价复杂型肛瘘的MRI分级及MRI诊断主管、支管、内口、脓肿的准确性。结果:复杂型瘘管T1WI可见10条或多条状等或稍低信号,T2WI、T2WI抑脂及SPAIR为高信号,增强扫描示瘘管壁明显强化、脓液不强化。MRI诊断与手术所见对照,显示肛瘘内口、外口、主管、支管和脓肿符合率分别为88.00%、100%、97.37%、70.00%和100%。结论:MRI在复杂型肛瘘术前诊断中具有较大的实用价值。     

肛瘘术前评估新方法:多层螺旋CT直肠填塞瘘管造影三维重组技术临床应用探讨

目的探讨多层螺旋CT（MSCT）直肠填塞瘘管造影三维重组技术及临床应用价值。资料与方法通过MSCT直肠填塞瘘管造影三维重组技术对31例临床拟诊或确诊肛瘘的患者行前瞻性研究,将结果与手术或临床结论对照。结果31例中27例为复杂性肛瘘,4例为单纯性肛瘘。对肛瘘内口诊断（截石点位及距肛门距离）的准确性、敏感性、特异性分别为93.9%、96.7%、66.7%。结论MSCT直肠填塞瘘管造影三维重组技术是肛瘘术前评估的一种新方法,能准确显示瘘管内口截石点位、定量诊断内口距肛门距离,多平面显示瘘管的性状及其与周围组织的关系,有较高的临床应用价值。     

Preoperative MR imaging of anal fistulas: Does it really help the surgeon?

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) imaging with a quadrature phased-array coil for the detection of anal fistulas and to evaluate the additional clinical value of preoperative MR imaging, as compared with surgery alone. MATERIALS AND METHODS: Fifty-six patients with anal fistulas underwent high-spatial-resolution MR imaging. Twenty-four had a primary fistula; 17, a recurrent fistula; and 15, a fistula associated with Crohn disease. MR imaging findings were withheld from the surgeon until surgery ended and verified, and surgery continued when required. RESULTS: MR imaging provided important additional information in 12 (21%) of 56 patients. In patients with Crohn disease, the benefit was 40% (six of 15); in patients with recurrent fistulas, 24% (four of 17); and in patients with primary fistulas, 8% (two of 24). The difference between patients with or without Crohn disease and between patients with a simple fistula versus the rest was significant (P <.05). The sensitivity and specificity for detecting fistula tracks were 100% and 86%, respectively; abscesses, 96% and 97%, respectively; horseshoe fistulas, 100% and 100%, respectively; and internal openings, 96% and 90%, respectively. CONCLUSION: High-spatial-resolution MR imaging is accurate for detecting anal fistulas. It provides important additional information in patients with Crohn disease-related and recurrent anal fistulas and is recommended in their preoperative work-up.     

质子加权预饱和脂肪抑制序列在肛瘘中的应用价值

目的评价质子加权预饱和脂肪抑制序列(PDW PFS)对肛瘘显示的准确性及图像质量的清晰性,探讨PDW PFS在肛瘘中的应用价值。资料与方法 20例经手术证实的肛瘘患者术前进行MRI检查,序列包括T1WI、T2W频谱选择性衰减反转恢复序列(SPAIR)和PDW PFS。MRI检查前均向患者肛管直肠内置入肛肠水囊以撑开肛管和直肠。获得图像后,观察患者的瘘管、内口和肛周脓肿,评估和比较MRI各序列显示的瘘管、内口、脓腔,并对PDW PFS和T2W SPAIR序列瘘管的信号强度(SI)、信噪比(SNR)及瘘管与周围肌肉的对比噪声比(CNR)进行测量及比较。结果 PDW PFS序列显示瘘管(100%)、内口(95.7%)、肛周脓肿(100%)的准确率较T1WI及T2WSPAIR序列为高。Kruskal Wallis检验显示上述各序列对瘘管(χ2=6.95,P<0.05)及内口(χ2=31.53,P<0.05)的显示具有显著统计学差异,PDW PFS序列显示瘘管及内口最多。PDW PFS序列SI、SNR值和CNR值均显著高于T2W SPAIR序列(P<0.05)。结论 PDW PFS成像技术具有较高的图像SNR和CNR,更易认识辨别瘘管和内口,可以作为一种新的无创性磁共振成像技术应用于肛瘘成像。     

MR不同序列成像诊断肛瘘的研究

目的 采用不同的序列诊断肛瘘，比较评价不同序列的临床应用价值。方法 15例临床怀疑肛瘘的患者，磁共振扫描序列:SE T1WI平扫及增强扫描，快速反转恢复序列(turbo inversion recovery magnitude,TIRM)；三维快速小角度激发成像平扫和增强图像减影(3D-fast low-angle shot image，3D-FLASH)及冠状面重建，比较3种序列肛瘘内、外瘘口及瘘管分支显示率。结果 1例为肛周脓肿，余14例患者发现24个不同类型的肛瘘，10例伴肛周脓肿，其中8例存在复杂性多分支瘘，3D-FLASH对肛瘘内、外口及瘘管系统显示率均高于SE T1WI增强及TIRM序列。结论3D-FLASH序列是诊断肛瘘的敏感检查方法，并能缩短检查时间。     

肛瘘的术前MRI表现与手术结果的对照分析

目的 探讨术前MRI检查对肛瘘诊断及分型的价值.方法 回顾性分析经手术证实的36例肛瘘患者的临床资料及MRI表现,并与手术结果对照分析,总结肛瘘的MRI表现特点及应用价值.结果 36例肛瘘手术显示内口42个,主瘘管45条、瘘管分支15条,外口42个,脓肿16个.与手术结果对照,MRI显示肛瘘内口的准确率为90.5%(38/42个),显示瘘管分支的准确率为80%(12/15条),显示主瘘管、外口及脓肿的准确率均为100%.按照Parks分型,MRI分型符合率为88.9%(32/36例).结论 MRI能准确显示肛瘘内、外口的位置,瘘管的数量及走行,能够对肛瘘进行准确分型.     

CO2激光治疗肛肠疾病470例

目的总结CO2激光治疗各种痔、肛裂及肛瘘等的疗效。方法外痔104例,内痔40例,混合痔288例,环形痔3例,低位肛瘘16例,肛裂19例,合计470例。以功率为15~20W、功率密度478或637mW/cm2的CO2激光刀割、凝固病变处。结果470例治愈率96·6%,有效率100·0%。术后发生水肿25例(5·3%)、疼痛30例(6·3%),少量出血13例(2·8%)。无一例发生排尿困难、尿潴留。结论CO2激光治疗常见肛肠科疾病,方法简便,疗效确切,并发症较少,可操作性较强。     

MSCT在复杂性肛瘘中的临床应用

目的:探讨复杂性肛瘘的多层螺旋CT(MSCT)影像表现及诊断价值。方法:回顾分析与手术相符的21例复杂性肛瘘,21例患者均行MSCT检查,以5mm层厚平扫或3mm层厚增强扫描和瘘道泛影葡胺注入后扫描,并行MPR、MIP及曲面重建,检查结果与手术对照。结果:MSCT检查复杂性肛瘘阳性率95.2%,复杂性肛瘘MSCT影像表现与手术结果相符,MSCT可显示瘘道内口、位置、走行及其分支。结论:MSCT诊断复杂性肛瘘准确性高,对肛瘘的诊治具有重要的临床价值。     

Radiologic diagnosis of anal fistulae with radio-opaque markers

Fistulography classifies anal fistulas in low-below puborectalis muscle-, high-above puborectalis muscle-, and middle. This classification increases the scope and accuracy of radical surgery. In order to improve the diagnostic reliability of anal fistulography the authors point out the importance of radio-opaque markers for anatomical definition of the anorectal region. Thirty patients (25 males and 5 females; mean age: 47 years) were studied by anal fistulography using radiopaque markers: a Foley's 22 Fr catheter, with distal balloon filled of idrosoluble radiopaque contrast medium, was placed in the anal canal; a metal marker was fixed to the anus. In order to demonstrate the relationship between fistula and puborectalis muscle, we subdivided the anal canal in 3 equal segments: high, middle and low. The idrosoluble contrast medium for fistulography is injected through a pediatric Foley's catheter 8 Fr when external opening is large enough, and through a K7072 endovenous catheter when the opening is small. Fistulous tract was visible in all patients: internal fistulous opening in 23/90 cases, and relationship of fistulous tract to puborectalis muscle in 25/30 (83.3%). In demonstrating either secondary fistulous tracts or abscesses, fistulography with radiopaque markers was correct in 60% of cases; in 20% of patients some of the above-mentioned complications were demonstrated, and in the 20% no complications at all were detected.     

肛瘘磁共振成像:探讨自制可调节肛肠水囊在肛瘘分级中的价值

目的:探讨普通MR成像中使用自制可调节肛肠水囊在肛瘘患者分级中的应用价值.方法:18例经手术证实的肛瘘患者于使用自制可调节肛肠水囊前、后均各行一次MRI检查.序列包括T_1 WI横断位和冠状位、T_2 W SPAIR横断位,冠状位及矢状位.放置水囊前后比较瘘管末端位置,并且对瘘管、内口、分支及脓腔进行计数,同时观察瘘管走行.所获结果被用于评估肛瘘MR诊断分级,并同时与手术结果相对照.结果:18名肛瘘患者MRI检查共发现瘘管31根、内口22个、分支19根以及脓腔10个.使用水囊前后MRI对瘘管末端位置的显示有显著不同(χ~2=5.56,P<0.05).使用水囊前,MR显示1例1级低位单纯线形括约肌内肛瘘,1例低位和2例高位2级括约肌内肛瘘伴脓肿或分支,1例3级高位经括约肌肛瘘,6例4级经括约肌肛瘘伴脓肿或分支,其中5例为高位,1例为低位,2例5级高位肛提肌上和经肛提肌肛瘘,另有5例无法确定;使用水囊后,2级高位括约肌内肛瘘伴脓肿或分支上升为3例,4级低位经括约肌肛瘘伴脓肿或分支上升至2例,高位上升至7例,另有1例无法确定,余小变.使用水囊前后,M RI对肛瘘分级与手术的相符率分别为72%(13例)和94%(17例).结论:通过使用自制町凋节肛肠水囊,普通M RI能够获得更多有关瘘管及其走行的信息,有助于肛瘘患者的分级.     

高分辨率MRI在复杂性肛瘘诊断中的价值研究

目的:探讨复杂性肛瘘的MRI表现及其临床诊断价值。方法:48例可疑复杂性肛瘘患者,行盆腔MR平扫检查,扫描序列包括横断面FSE-T1WI、T2WI、T2WI抑脂及STIR扫描,矢状面STIR及T2WI扫描,冠状面STIR及T2WI抑脂扫描。分析肛瘘的MRI表现,评价瘘管与内外括约肌的关系及复杂性肛瘘的分型,比较内、外口的显示率,将诊断结果与手术进行对照。结果:瘘管于T1WI表现为条状略低信号,T2WI、T2WI抑脂及STIR序列呈明显高信号,以抑脂像病灶显示最佳。MR诊断与手术比较符合率分别为:肛瘘(或脓肿)96.9%,内口82.4%,外口100%,分型86.7%。结论:MRI是复杂性肛瘘的一种重要诊断方法,具有重要的临床价值。     

Endoanal magnetic resonance imaging of fistula-in-ano: a comparison of STIR with gadolinium-enhanced techniques

PURPOSE: To compare a STIR sequence with gadolinium-enhanced techniques on endoanal magnetic resonance (MR) imaging of fistulas-in-ano by correlating the findings with those at surgery. MATERIAL AND METHODS: Twenty-two consecutive patients with clinical suspicion of perianal sepsis were studied using an endoanal coil followed immediately by a phased array coil. T1-weighted precontrast and postcontrast and STIR images in transverse and coronal planes were produced with each coil and analysed by noting the presence and site of a collection, primary track, the position of any internal opening, and subcutaneous or supralevator extension. An "expert" and also a "trainee" radiologist assessed the images. Operative findings were similarly recorded. The Fisher exact test was used to compare imaging with surgery. Interobserver variation was calculated using a kappa statistic. RESULTS: Of 22 patients with suspected fistulas, 8 were simple, 4 were complex, and 3 were superficial sinuses. Five had no anal pathology, 1 had anal excoriation, and 1 had a polyp. At surgery, 6 intersphincteric, 1 transsphincteric, 8 extrasphincteric, no supralevator collections, and 9 internal openings were noted. The overall sensitivity and specificity for detecting these were 75% and 64%, respectively, for STIR imaging, and 58.3% and 62.8% for gadolinium-enhanced imaging. There was good agreement between the "trainee" and the "expert" in the interpretation of images (kappa=0.7). CONCLUSION: A STIR sequence is more sensitive overall than gadolinium-enhanced techniques on endoanal magnetic resonance imaging of fistulas-in-ano because of increased sensitivity in detecting the internal opening. A combination of endoanal and phased array techniques using STIR imaging sequences is valuable preoperative assessment in both simple and complex cases.     

CO2激光治疗肛瘘185例报告

为总结ＣＯ２激光治疗肛瘘的方法及经验，应用ＣＯ２激光治疗１８５例肛瘘患者。低位单纯性肛瘘１６５例、低位复杂性肛瘘１４例、高位单纯性肛瘘３例、高位复杂性肛瘘３例。采用布比卡因、亚甲蓝肛管部浸润麻醉，持ＣＯ２激光沿瘘管外壁剔除全部瘘管；或者切开全部瘘管后，用激光光束汽化、凝固管腔内的腐烂组织及管壁的瘢痕组织。高位瘘管应与挂线疗法相结合，范围广泛的肛瘘应分期手术。经１～６年临床观察，痊愈者１８３例（治愈率９８．９％）、复发２例（复发率１．１％）。该法具有止血效果好、抗感染作用强、术后痛苦小、瘢痕小、肛门不变形、操作简单、不需住院等优点。     

超声、CT及MRI在评价体表窦瘘中的对照研究

目的:探讨CT、MRI及超声检查在体表窦瘘中的应用价值。方法:回顾性分析53例体表窦瘘患者的临床和影像资料,患者术前均行CT、MRI及超声检查,对照手术所见,评价3种影像学方法对体表窦瘘的诊断准确率及对复杂性窦瘘支管、脓肿及内口显示的敏感度。结果:53例中,单纯窦道22例,复杂性窦瘘31例。单纯窦道患者CT、MRI及超声检查的准确率分别为100%、100%、95.45%,其差异无统计学意义(P0.05);复杂性窦瘘患者CT、MRI及超声检查的准确率分别为93.55%、96.77%、70.97%,其差异有统计学意义(P0.05),CT与MRI的准确率优于超声,而CT与MRI的诊断准确率差异无统计学意义(P0.05)。CT、MRI及超声检查对复杂性窦瘘支管的敏感度分别为95.24%、98.41%、55.56%,脓肿的敏感度分别为90.00%、100%、70.00%,内口的敏感度分别为80.00%、80.00%、40.00%。对于支管显示的敏感度,CT与MRI高于超声(P0.05),CT与MRI间差异无统计学意义(P0.05)。对于脓肿及内口显示的敏感度,三者间差异无统计学意义(P0.05)。结论:对于单纯窦道,超声检查方便经济;复杂性窦瘘,CT、MRI检查存在很大优势。     

高频线阵型超声诊断肛瘘的价值

目的: 探讨高频线阵型超声诊断肛瘘的价值.材料和方法: 使用GE Logiq 7型彩色超声波诊断仪及10 MHz高频线阵型探头对29例肛瘘患者进行检查, 并与手术结果对照.结果: 超声诊断括约肌间肛瘘17例内口22个、经括约肌肛瘘6例内口8个、括约肌上肛瘘4例、括约肌外肛瘘2例,与手术后诊断比较,肛瘘类型诊断符合率分别为17/17、6/6、3/4和1/2.结论: 高频线阵型超声能较清晰地显示肛瘘瘘管的部位、走行及内口,可为肛瘘的明确诊断和手术方案的制定提供较有价值的信息.