端扫式凸阵腔内探头与旋转式腔内探头术前超声评估肛瘘准确性的比较

Evaluation of the accuracy of end-fire endoprobe and rotating endoprobe in the preoperative assessment of anal fistula

目的应用端扫式凸阵腔内探头与旋转式腔内探头对肛瘘进行术前超声评估,比较两种超声探头诊断肛瘘准确性的差异。方法回顾性分析2009年6月至2010年6月我院以肛瘘收入院拟行手术治疗的130例患者的临床资料。其中66例患者术前应用端扫式凸阵腔内探头进行肛瘘超声评估,64例患者术前应用旋转式腔内探头进行肛瘘超声评估。评估内容包括肛瘘主支(Parks分型)、分支、内口和慢性脓腔。将术前超声评估结果与手术结果进行对比分析。结果端扫式凸阵腔内探头与旋转式腔内探头肛瘘术前超声评估结果与手术探查结果的符合率分别为:肛瘘主支Parks分型中括约肌间型为96.3%(52/54)与97.9%(46/47),经括约肌型为60.0%(3/5)与75.0%(6/8),括约肌上型为85.7%(6/7)与77.8%(7/9);肛瘘有分支为100%(5/5)与75.0%(6/8),无分支为95.1%(58/61)与96.4%(54/56);肛瘘内口位置为95.5%(63/66)与96.9%(62/64);有慢性脓腔均为100%(4/4,7/7),无慢性脓腔为96.8%(60/62)与96.5%(55/57)。两种探头术前超声评估结果与手术探查结果符合情况的差异无统计学意义(χ2=0.003、0.177、0.185、0.001,P均>0.05)。端扫式凸阵腔内探头可对肛管矢状面、冠状面、斜切面进行扫查,能够显示瘘管的长轴与短轴;旋转式腔内探头可显示肛管轴向切面中肛瘘的图像。肛瘘内口在端扫式凸阵腔内探头下表现为肛门内括约肌局部低回声缺损;旋转式腔内探头可显示瘘道与肛门内括约肌相交处肛瘘内口的特征。结论端扫式凸阵腔内探头与旋转式腔内探头均可在术前准确评估肛瘘的解剖形态以及与肛门括约肌的关系,可为外科医师制定手术方案提供有帮助的信息。

Objective To compare the diagnostic accuracy of endoanal ultrasound in the pre- operative assessments of anal fistulas between end-fire endoprobe and rotating endoprobe. Methods The preoperative endoanal ultrasound images of 130 patients with anal fistula were retrospectively analyzed. The examination was performed from June 2009 to June 2010. Sixty-six patients with 7 MHz end-fire endoprobe and 64 patients with 7. 5 MHz rotating endoprobe. Imaging assessment included primary track （Parks＇s classification） , secondary tracks, internal opening and cavities. The results were subsequently compared with surgical findings. Results The coincidence rate of end-fire endoprobe and rotating endoprobe diagnosis with surgical findings are ： in primary track （ Parks＇s classification ）, 96. 3% （ 52/54 ） and 97. 9% （ 46/47 ） of intersphincteric fistulas ,60.0% （ 3/5 ） and 75.0% （6/8） of transsphincterie fistulas, 85.7% （ 6/7 ） and 77.8% （7/9） of suprasphincteric fistulas ; 100% （ 5/5 ） and 75.0% （ 6/8 ） of having secondary tracks, 95.1% （ 58/61 ） and 96.4% （ 54/56 ） without secondary tracks ; 95.5% （ 63/66 ） and 96.9% （ 62/64 ） of internal opening; 100% （ 4/4 ） and 100% （ 7/7 ） of having cavities, 96.8 % （ 60/62 ） and 96.5 % （ 55/57 ） without cavities. The coincidence rate of ultrasound assessments and surgical findings have no statistically significant differences between the two types of endoprobes （X2 = 0. 003,0. 177,0. 185,0. 001, all P 〉 0.05 ）. End-fire endoprobe can scan sagittal plane, coronal plane and oblique section of anal canal, it can also display longitudinal plane and transverse plane of anal fistula; Rotating endoprobe can show anal fistula in axial plane. The internal opening demonstrated as a rupture in the internal anal sphincter with end-fire endoprobe;as an intersection of the internal anal sphincter and anal fistula with rotating endoprobe. Conclusions The two types of endoprobes have the similar accuracy for the preoperative assessments of anal fistula anatomy and its relationship with anal sphincters. It can provide valuable information for surgical strategy.