经肛门灌肠造影多层螺旋CT扫描对结直肠阴道瘘的诊断价值

目的探讨经肛门泛影葡胺灌肠后行多层螺旋CT扫描检查诊断结直肠阴道瘘的价值。方法本组11例病例中，5例为阴道残端乙状结肠瘘，4例为阴道残端直肠瘘，2例为直肠阴道瘘，均经手术证实。所有病例均行泛影葡胺灌肠检查及盆腔多层螺旋CT检查；将0．625mm层厚和层间距图像传至工作站进行图像后处理，利用后处理软件获取盆腔结直肠阴道瘘的三维重建图像。结果通过CT重建图像发现，乙状结肠阴道瘘5例，直肠阴道瘘6例；其中4例在盆腔内可见“湖状”造影剂积聚。多平面重组图能够清楚显示对比剂在直肠、乙状结肠、阴道内存留，以及对比剂在盆腔内团状积聚，还可清楚显示瘘口的位置、大小和对比剂在肠管内、阴道内的走行方向。结论泛影葡胺对比剂灌肠后行多层螺旋CT检查，可极大提高结直肠阴道瘘检查的准确性，为临床手术方案的制定提供准确的诊断依据。

Multi-slice spiral CT scaning with anal enema contrast for colorectal vaginal fistula

Objective To explore the value of multi-slice spiral CT scaning with anal diatrizoate meglu- mine enema in the diagnosis of colorectal vaginal fistula. Methods Of 11 patients with pathologically confirmed fistula, 5 had fistula of sigmoid colon and vaginal stump, 4 had vaginal stump fistula, and 2 had rectovaginal fis- tula. All the patients underwent diatrizoate enema and pelvic muhi-slice CT scanning. The images with layer thickness of 0.625 mm were transmitted to the workstation; the post-processing software was used to obtain three-dimensional reconstruction images of pelvic colorectal vaginal fistula. Results Sigmoid-vaginal fistula was found in 5 patients, and rectovaginal fistula in 6; 4 of which had lake-shaped accumulation of contrast agent on the pelvic CT images. The multi-planar reconstruction image clearly showed the contrast agent stayed in the rec- tum, sigmoid colon, and vagina, a mass accumulation of contrast agent in the pelvic cavity, location of the fistu- la, and moving direction of contrast agent within the bowel and vagina. Conclusions Multi-slice CT scanning with diatrizoate enema contrast greatly improve the diagnostic accuracy of the colorectal vaginal fistula and pro- vide an accurate support for the development of clinical surgery scheme.