术前磁共振检查在复杂性肛瘘手术中的临床意义

Clinical Significance of Magnetic Resonance Imaging before Complex Anal Fistula Surgery

目的探讨术前磁共振(MRI)检查对复杂性肛瘘手术的临床意义。方法将80例复杂性肛瘘患者分为低位观察组、低位对照组、高位观察组、高位对照组四组,每组20例。低位观察组和高位观察组术前进行MRI检查,记录内口位置、数目,并与术中情况进行比较;低位对照组和高位对照组术前单依靠临床经验诊断,不进行MRI检查。对四组的术后手术次数、再次手术率、愈合时间、半年后复发率进行比较。结果低位观察组与低位对照组比较,在术中发现内口数量、手术次数、再次手术率、愈合时间及复发情况方面,两组差异均无统计学意义(P>0.05)。而高位观察组与高位对照组比较,在术中发现内口数量、手术次数、愈合时间方面,两组差异有统计学意义(P<0.05)。高位对照组的再次手术率高于高位观察组,无统计学差异(P>0.05);高位观察组的MRI内口部位准确率高于低位观察组,无统计学意义(P>0.05)。结论术前MRI检查能提高高位复杂性肛瘘的临床疗效,应成为高位复杂性肛瘘的术前常规检查项目。

Objective To explore the clinical significance of magnetic resonance imaging（MRI）before complex anal fistula surgery.Methods 80 cases of complex anal fistula were divided into a low-level fistula observation group,a low-level fistula control group,a high-level fistula observation group and a high-level control group,20 cases in each one.Before the surgery,MRI was performed in low-level fistula observation group and high-level fistula observation group.The location and number of internal opening were recorded and compared with those discovered in the surgery.In low-level control group and high-level control group,the diagnosis relied only on the clinical experience before the surgery,without MRI performed.The comparison was conducted after the surgery among four groups in terms of the surgical frequency,re-surgical rate,healing time and the recurrence rate in half a year.Results In comparison between low-lever fistula observation group and low-level fistula control group,it was found during the surgery that there were no statistical significant differences in the number of internal opening,surgical frequency,re-surgical rate,healing time and the recurrence rate（P0.05）.In comparison between high-level fistula observation group and high-level fistula control group,it was discovered during the surgery that the significant statistical differences presented in the number of internal opening,surgical frequency and healing time（P0.05）.The re-surgical rate in high-level fistula control group was higher than that in high-level observation group,but without statistical different significance（P0.05）.The precision for the location of internal opening in MRI in high-level fistula observation group was higher than that in low-level fistula operation,but without statistical different significance（P0.05）.Conclusion MRI before the surgery can improve the clinical efficacy on high-level complex anal fistula and this examination should become the routine examination item before the surgery for high-level complex anal fistula.