磁共振成像在先天性肛门直肠畸形临床诊断和治疗中的应用价值

Application value of MRI in clinical diagnosis and treatment of anorectal malformation

目的探讨磁共振成像(MRI)在小儿先天性肛门直肠畸形中的诊疗价值及预后评估。方法搜集2008年2月至2011年8月经手术治疗的先天性肛门直肠畸形患儿57例,术前均行MRI检查。结果 57例患儿中包括高位型肛门闭锁23例,直肠盲端均在耻骨尾骨线(PC线)以上,其到肛门窝的距离平均约3.2 cm,其中合并脊髓栓系3例(Currarino综合征2例)、骶尾骨发育畸形2例、肾盂积水2例、融合肾畸形1例、双子宫畸形1例、直肠阴道瘘1例;中间位型肛门闭锁16例,直肠盲端与PC线基本平齐,其到肛门窝的距离平均约1.5 cm,其中合并脊髓栓系1例,骶骨发育不全2例,肾盂积水1例;低位型肛门闭锁18例,直肠盲端均位于PC线以下,其到肛门窝的距离平均约0.8 cm,其中脊髓栓系1例,直肠会阴瘘6例,骶尾骨发育畸形1例,肾盂积水2例。高位组的伴发畸形率及术后并发症的发生率明显高于中低位组。2例Currarino综合征得到全面矫治,预后良好。结论 MRI可以准确、全面详尽地显示肛门直肠畸形的类型、瘘管的存在与走行、脊髓及腰骶椎发育情况,伴发的其他畸形情况,为手术方式及麻醉方式的选择、并发症的预测及术后的预后评估提供可靠的依据。

Objective To investigate the application value of MRI in clinical diagnosis and treatment of anorectal malformation. Method 57 cases with operatively anorectal malformation from February 2008 to August 2011 were collected. All the patients received MRI examination before the operation. ResultsOf the 57 cases, 23 cases had high imperforate anus with rectum blind end above PC line and the average distance from the nest to the anus was about 3.2cm, 3 cases combined with spinal cord（2 cases with Currarino syndrome）, 2 cases with sacrococcyx malformation. There were 2 cases with renal pelvis, 1 case with renal malformation, 1 case with rectovaginal fistula,and 1 case with double uterine malformation. 16 cases had median imperforate anus with rectum blind end near PC line. The average distance from the nest to the anus was about 1.5cm. There was 1 case combined with tethered spinal cord, 2 cases with sacral agenesis and 1 case with hydronephrosis. 18 cases had low imperforate anus with the rectum blind end below PC line. The average distance from the nest to the anus was about 0.8cm. There was 1 case combined with tethered spinal cord, 6 cases with rectal perineal fistula, 1 case with sacrococcyx malformation,2 cases with hydronephrosis. Incidence rate of postoperative complications in high imperforate anus was higher than the low imperforate anus. Conclusions MRI can display the anorectal malformation type, the presence and walk of fistula, development of spinal cord and lumbarsacral vertebra, and other abnormal conditions accurately and comprehensively. It can offer reliable basis for the choice of operation and anesthesia mode, prediction of complications and evaluation of postoperative prognosis.