三维肛管直肠腔内超声在肛瘘诊治中的应用

Application of three-dimensional endoanal and endorectal ultrasound in the diagnosis of anorectal fistula

目的 探讨三维肛管直肠腔内超声定位肛瘘内口、显示瘘管走行的价值.方法 2008年11月至2010年1月应用三维肛管直肠腔内超声检查肛瘘患者127例,在三维立体模块中根据声像图特征进行内口定位、瘘管走行追踪.结果 定位内口116例,准确率91.3%（116/127）,其中112例患者内口开口于齿线处,4例发现内口于直肠壶腹;127例患者定位主管,准确率100%（127/127）,其中经括约肌瘘75例,括约肌间瘘47例,括约肌上瘘2例,括约肌外瘘3例;定位支管37例,准确率100%（37/37）.结论 应用三维肛管直肠腔内超声检查肛瘘,能够准确定位内口、显示瘘管走行,能为临床治疗方法的选择提供必要的诊断依据.

Objective To evaluate the efficacy of three-dimensional anal and endorectal ultrasound in identifying the internal opening and tracing the tract of the anorectal fistula. Methods From November 2008 to January 2010, 127 patients suffering anorectal fistula were managed with three-dimensional endoanal and endorectal ultrasound. The internal opening, the tract of the fistula and fistula trace were identified by the ultrasonography with three-dimensional imaging. All results were confirmed and compared with findings from the operation. Results The internal opening of the fistula was specified in 116 patients, the accuracy rate was 91.3% （116/127）. The internal opening of the fistula was located above the dentate line in 112 patients, and located in rectal ampulla in 4 patients. The main fistula tract was identified in all the patients,the accuracy rate was 100%. In this group, the fistula tunneled as follows： trans-sphincteric in 47 patients,intersphincteric in 75 cases, suprasphincteric in 2 cases, extrasphincteric in 3 patients. Secondary extension was found in 37 patients,the accuracy rate was 100% （37/37）. Conclusions Three-dimensional anal and endorectal ultrasound is an effective way for localizing the internal opening and the tract of anorectal fistula.It can provide valuable information for curative operation.