三维肛肠超声诊断肛瘘的临床应用价值

Clinical Applicable Value of Three Dimensional Endoanal Ultrasound for Diagnosing Anal Fistula

为探讨三维肛肠超声扫描结合瘘管双氧水造影在肛瘘诊治中的临床应用价值，对14例肛瘘患者进行，三维肛肠超声检查，将术前获取的三维超声重建图像资料与肛瘘手术结果进行比较。结果显示，14例均经三维肛肠超声检查，10例为单纯性肛瘘，4例为复杂件肛瘘；其中低佗肛瘘5例，高位肛瘘9例，均经手术证实；其中三维肛肠超声检查括约肌间瘘7例，经括约肌瘘4例，括约肌上瘘3例（而手术证实为括约肌间瘘6例，经括约肌瘘5例，括约肌上瘘3例）。三维肛肠超声结合双氧水造影能准确提高瘘管内口及支管的显影，14例患者存在15个肛瘘内口及2例存在支管，其中1例存在1个潜在内口。结果表明，三维肛肠超声瘘管三维图像重建可清晰显示瘘管的具体位置（内、外口）、形态、走行特点及其与肛管内外括约肌、肛提肌、耻骨直肠肌的关系。三维肛肠超声结合瘘管双氧水造影可以精确地对肛瘘进行定位、分型诊断，为手术提供最直观、立体、准确的依据。

The objective of this study was to explore the clinical applicable value of three dimensional endoanal ultrasound scanning combined with H2O2 visualization for diagnosing ＆ treating anal fistula. The 14 cases with anal fistula received the three dimensional endoanal ultrasound exam. The three dimensional ul- trasound reconstruction image date which was obtaind preoperatively was compared with operative out come. As results,the fistula of the 14 cases were all checked up：simple one in 10 cases,complex one in 4 cases;low one in 5 cases,high one in 9 cases,which were all confirmed by operation;by three dimensional ul- trasound exam intersphincteric fistula was in 7 cases, trans-sphincteric one in 4 cases, super-sphincteric one in 3 cases,while operation confirmed outcome was 6,5,3 cases respectively, three dimensional endoanal ul trasound combined with H2O2 visualization could enhance appearance image accuracy of inner-opening and branch of fistula tract in the 14 cases：there were 15 inner-opening and the branch tracts of 2 cases（among them,one case had one potential inner opening）. Results showed that the three dimensional image recon struction of three dimensional ultrasound exam. for anal fistula can clearly show the location（inner and out opening）, form, distribution features,and their relationship with anal inter and exter-sphincter, levator ani muscle and musculus puborectalis,so that three dimensional endoanal ultrasound exam combined with H2O2 visualization can accurately perform location and typing diagnosis for anal fistula,thus providing the intuitional,spatial and accuracy basis for operation.