磁共振成像在复发性肛瘘中的应用价值

为探讨磁共振成像（magneticresonanceimaging，MRI）在复发性肛瘘中的应用价值，回顾40例复发性肛瘘患者的MRI表现，总结分析其内口位置特点、瘘管走行形态以及肛提肌侵犯范围等。MRI采用Philips1．5T超导型磁共振扫描机，软体线圈，检查体位为仰卧位。采用横断：TIWI自旋回波（SE）序列，T2WI快速自旋回波（FSE）序列，T2WI脂肪抑制（FAT—SAT）序列。冠状及斜冠状位：T2WIFSE序列。层厚5ram，间隔lmm。结果显示，40例复发性肛瘘患者均为高位肛瘘，手术证实均存在内口，其中38例术中所见与MRI表现一致，该38例患者内口均位于肛窦附近（32例存在1个内口，6例存在2个内口）；另2例MRI检查各序列及断面均未显示内口。瘘管长度7．0～16．0cm（其中走行平直23例，走行迂曲17例）；瘘管宽度0．8～3．0cm。瘘管走行于肌间者32例，走行于肛提肌内者8例。本组患者瘘管壁均不规则，其厚度为0．3～1．0cm。瘘管存在支管者11例；内盲瘘1例。瘘管仅侵犯耻骨直肠肌者4例，仅侵犯髂骨尾骨肌者9例，耻骨直肠肌及髂骨尾骨肌同时受侵27例；并发瘘管组织癌变1例。结果表明，MRI能准确显示内口的位置、瘘管走行及肛提肌受侵范围、程度，在复发性肛瘘术前检查中具有重要作用。

Applied Value of Magnetic Resonance Imaging in Recurrence Anal Fistula

The objective of the study was to investigate the applied value of magnetic resonance imaging （MRI） in recurrence anal fistula. Author reviewed the MRI findings of 40 cases with this disease,and analysed their location features of fistula internal opening, form and distribution direction of fistula fistulous, and infiltration range to levator ani muscle,etc. MRI was performed as following：using Philips 1.5 T superconducting-type MR scanner, soft-body coil, patients being in supine position; adopt traverse-section. TIWI spin echo（SE） sequence,T2WI fast spin echo（FSE） sequence and T2WI fat-saturation （FAT-SAT） sequence;coronary and obliquity coronary position： T2WI FSE sequence; layer-thick 5mm, space lmm. As results, the 40 cases were all high fistula, has fistula internal opening confirmed by operation, among whom the operative findings of 38 cases accorded with MRI performance,their internal opening were all located the site close anal sinus（32 cases had only one opening,6 cases had two opening）;in rest two cases MRI of each sequence and section did not display internal opening;the length of fistula fistulous was 7.0-16.0 cm （in 23 cases the distribution directing was straight, in rest 17 cases,was sinuous）,the width was 0. 8-3. 0cm;in 32 cases, there were intermuscle direction of fistula fistulous,while in rest 8 cases intra-musculus levator ani. The wall of fistula fistulous in the 40 cases was all of irregularity,its width was 0.3-1.0 cm;the fistulous of 11 cases had internal branch,one case had blind-fistula;in 4 cases fistulous only infiltrated pubo-reetal muscle,in 9 cases only ilium-coceygeal muscle,in 27 cases together both mucles, and complicated carcinomatous conversion of fistula tissue in one case occured. Results show that MRI can accurately display the location of fistula internal opening, the distribution direction of fistula fistulous, as well the infiltrated range and extents levator ani muscle,thus it has important roles in pre-operative scan for recurrents anal fistula.