肛门直肠周围脓肿术前多层螺旋CT检查的临床价值

The Clinical Value of Multi Slice Spiral CT Examination in Preoperative Assessment of Perianal and Rectal Abscess

目的探讨术前多层螺旋CT对肛门直肠周围脓肿的临床诊断价值。资料与方法回顾性研究经手术病理证实的15例肛门直肠周围脓肿患者资料,其中男11例,女4例;年龄24～72岁,平均35.5岁。全部按常规盆腔CT平扫,其中有7例行CT增强扫描,然后全部行多平面重组(MPR)矢状面和冠状面重组、6例行斜冠状面重组。结果15例肛门直肠周围脓肿患者,术前CT发现有脓肿共18处,厚壁脓腔15例、脓肿内含气13例、周围结构欠清15例。增强扫描呈环形强化7例,边缘欠规则6例。其中按解剖分:肛提肌上部脓肿4例,肛提肌下部脓肿11例。按感染细菌分:大肠杆菌11例、其他厌氧菌2例、葡萄球菌1例、链球菌1例。所有病例手术病理结果与术前CT解剖定位结果吻合。术后所有病例恢复良好,无一例合并有肛瘘。结论肛门直肠周围脓肿术前多层螺旋CT检查对诊断、手术治疗及预后有较高的临床价值。

Objective To assess the value of MSCT in diagnosis of perianal and rectal abscess before operation. Materials and Methods Fifteen patients （11 males,4 females,24 to 72 years old with average 35.5 years） with perianal and perirectal abscess were studied retrospectively. All the cases performed routine pelvic CT scan,7 cases performed CT enhancement scann. MPR,including sagittal plane and coronal reconstruction （15 cases）,oblique coronal reconstruction （6 cases）were applied. Results Eighteen abscess were detected in CT images before operation. CT features included thick wall abcess （15 cases）,air-contained abcess cavity（13 cases）,blur surrounding structure （15 cases）. 15 cases showed brim enhancement in CT enhancement images. According to anatomy,4 case located above levator anim and 11 cases below levator anim. The infective bacterium included bacillus coli （11 cases）,other anaerobian （2 cases）,staphylococci （1 cases）,chain coccus （1 case）. The results of surgery pathology were consistent with the CT results. Conclusion Preoperative MSCT examination of perianal and perirectal abscess has great chinical value in the diagnosis and surgical treatment.