磁共振直肠阴道造影对于直肠阴道瘘的诊断价值

Value of MR in the Diagnosis of Rectovaginal Fistula

目的探讨MR直肠阴道造影对于直肠阴道瘘的临床诊断价值。方法由两位放射科医师回顾性分析27例MRI诊断为直肠阴道瘘患者的MRI资料,记录直肠侧内口个数、位置及瘘管支数,以手术、肠镜结果为金标准分析MRI结果的准确性。结果 27例中22例行手术、肠镜检查,发现直肠侧内口21个,直肠阴道间瘘管22支,MRI显示内口的准确性为95.5%(21/22),瘘管显示准确性为100%(22/22)。MR定位直肠侧内口到肛缘距离与手术及肠镜结果比较差异无统计学意义(t=1.508,P>0.05)。合并脓肿和肛瘘1例,肛门内外括约肌及会阴深横肌损伤者2例。结论 MR直肠阴道造影能够直观、准确评估直肠阴道瘘,指导手术治疗。

Objective To evaluate the Value of MR in the diagnosis of rectovaginal fistula. Methods 27 patients with rectovaginal fistula performed MRI before operation. MR images were analyzed retrospectively by two radiologists. Location and number of internal fistula opening, fistula were recorded. MRI findings were analyzed by comparing with the surgical and colonoseopy results. Results 22 patients performed surgery or colonoseopy, and found 21 internal fistula openings beside rectum,22 fistulas between rectum and vanigal. The accuracy of diagnosing internal fistula openings and fistula were 95.5 % （21/22 ） and 100% （22/22）. There was not significant difference between M RI findings and surgical or eolonoscopy findings （ t = 1. 508, P 〉 0.05 ）. On MRIimaging, rectovaginal septal abscess were showed in 4 cases, anal fistula in 1case, rectovaginal septal abscess and anal fistula in 1 case, sphincter and perineum deep transverse muscle injury in 2 cases. Conclusion MRI is a sensitive method to diagnose the rectovaginal fistula, which provides anatomic and pathologic information necessary for surgical management.