二维和三维腔内超声技术应用于肛瘘诊断的比较研究

Comparison of two-dimensional ultrasound and three-dimensional endoanal ultrasound in the diagnosis of perianal fistula

目的：评估二维和三维腔内超声技术诊断肛瘘的准确性。方法收集2012年1—12月南京市中医院肛肠科住院接受手术治疗的47例肛瘘患者临床影像资料。以术中探查结果为金标准，对二维和三维两种腔内超声检查的诊断结果进行kappa一致性检验。结果二维和三维腔内超声对瘘管内口的诊断均表现出与术中探查结果较好的一致性（kappa系数0．776比0．636）；三维腔内超声对括约肌间瘘、高位经括约肌瘘和括约肌上瘘的诊断与术中探查结果的一致性均极好，并优于二维超声，kappa系数分别为0．810比0．592，0．863比0．548，1．000比0．672；对于分支瘘管的诊断，三维超声也优于二维超声（kappa系数分别为0．659比0．535）；对于合并脓肿的诊断，三维和二维超声一致性均极好（kappa系数：0．881比0．816）。结论三维腔内超声能清晰显示瘘管与括约肌的关系，尤其对高位、合并分支瘘管的复杂性肛瘘，较二维超声的诊断准确性更高。

Objective To compare the accuracy of two-dimensional endoanal ultrasound （2D-EAUS） and three-dimensional endoanal ultrasound （3D-EAUS） in the diagnosis of perianal fistulas. Methods Image data of 47 perianal fistula patients undergoing surgery in our department between January 2012 and December 2012 were collected. All the patients underwent 2D-EAUS and 3D-EAUS , and the results were compared to intraoperative findings （gold standard） by kappa concordance test. Results Both 2D-EAUS and 3D-EAUS showed good concordance with intraoperative findings in internal opening （kappa： 0.776 vs. 0.636）. 3D-EAUS had better concordance with intraoperative finding in the diagnosis of intersphincteric , high transsphincteric and suprasphincteric fistulas as compared to 2D-EAUS （kappa： 0.810 vs. 0.592, kappa： 0.863 vs. 0.548, kappa： 1.000 vs. 0.672）. 3D-EAUS showed better concordance with intraoperative findings in secondary tract compared to 2D-EAUS （kappa： 0.659 vs. 0.535）. Both 2D-EAUS and 3D-EAUS had good concordance with intraoperative findings in complicated abscesses （kappa： 0.881 vs. 0.816）. Conclusion 3D-EAUS can show the relationship of fistula with anal sphincter , especially in diagnosing high fistula and fistula with secondary tracts, and has a higher diagnostic accuracy than 2D-EAUS.