先天性肛门直肠畸形伴瘘管的MRI与造影检查

Magnetic resonance inmging and radiography for congenital anorectal malformation with fistula

目的探讨MRI与造影检查在先天性肛门直肠畸形（congenital anorectal malforIna—tions，CARM）瘘管诊断中的临床应用价值并将两者进行对照研究。方法回顾性分析我院2008年5月至2012年12月经手术治疗并确诊的先天性肛门直肠畸形伴发瘘管患儿26例，男17例，女9例，年龄1d至36个月。患儿术前均行MRI及造影检查。结果CARM伴发瘘管26例中，高位肛门闭锁型CARM11例，其中会阴瘘7例，膀胱瘘2例，尿道瘘1例，阴道瘘1例；中位肛门闭锁型CARM9例，其中会阴瘘5例，尿道瘘3例，阴道瘘1例；低位肛门闭锁型CARM6例，其中会阴瘘5例，阴囊根部体表瘘1例。MRI诊断瘘管的准确率为57．96％（15／26），造影检查诊断瘘管的准确率为88．46％（23／26），两者之间经统计学处理有显著性差异（x2=9．65，P〈0．01）。结论MRI与造影检查在诊断CARM瘘管方面具有很高的临床应用价值。MRI诊断瘘管的准确率明显低于造影检查，两者相结合可以有效的提高瘘管诊断准确率，减少患儿X线辐射剂量及创伤，优化影像学检查方法。

Objective To explore the clinical values of magnetic resonance imaging （MRI） and radiography examination for congenital anorectal malformation （CARM）. Methods A total of 26 cases with surgically proved CARM with fistula from May 2008 to December 2012 at our hospital were re- viewed. There were 17 males and 9 females with an age ranige of 1 day to 36 months. MRI and radio- graphy were performed. Results Among them, there were high imperforate anus （n = 11）, perineal fistula （n = 7）, bladder fistula （n = 2）, urethral fistula （n = 1）, vaginal fistula （n = 1） ; median imper- forate anus （n= 9）, perineal fistula （n= 5）, urethral fistula （n = 3）, vaginal fistula （n = 1） low im- perforate anus （n = 6）, perineal fistula （n = 5） and scrotal root surface fistula （n = 1）. The MRI diag- nostic accuracy rate was 57. 96 % （15/26） and radiographic diagnostic accuracy rate 88. 46% （23/26）. And there were statistically significant differences （X2 = 9. 65, P〈0. 01）. Conclusions MRI and radio graphy have high clinical diagnostic values for CARM with fistula. Diagnostic accuracy of MRI is significant- ly lower than that of fistula angiography. And a combination of both may effectively improve the diagnostic accuracy of fistula, reduce radiation dose, lessen trauma and optimize imaging modalities.