MRI远端结肠造影检查对先天性肛门直肠畸形造瘘术后瘘管的诊断价值

Diagnostic Value of Fistulas Detected by MRI Distal Colostogram in Patients with the Congenital Anorectal Malformation After Colostomy

目的探讨MRI远端结肠造影检查对先天性肛门直肠畸形（CARM）造瘘术后瘘管的诊断价值。方法搜集CARM造瘘术后伴瘘管患儿24例,包括17例中高位型、3例低位型及4例一穴肛患儿,均行常规盆底MRI和MRI远端结肠造影检查,采用χ-2检验评价两种检查方法对显示瘘管的准确性。结果 24例CARM造瘘术后患儿手术探查均证实有瘘管,17例中高位型中,直肠膀胱颈部瘘1例,直肠尿道前列腺部瘘11例,直肠尿道球部瘘4例,直肠阴道瘘1例;3例低位型,直肠前庭瘘1例,直肠舟状窝瘘1例,直肠会阴瘘1例;4例一穴肛均为简单性,其中共同通道长约1 cm和2 cm各2例。常规MRI图像显示瘘管5例,准确性为20.8%（5/24）。MRI远端结肠造影检查中21例显示瘘管,准确性为87.5%（21/24）,两者差异有统计学意义（χ-2=21.483,P〈0.01）。结论 MRI远端结肠造影检查可很好显示CARM造瘘术后患儿直肠形态、肠内容物、瘘管的有无及其走行、长度及瘘与直肠的关系,明显优于常规MRI检查,为手术方式的选择提供更详细的信息,有助于预防术后并发症。

Objective To evaluate diagnostic value of fistulas by MRI distal colostogram in patients with the congenital anorectal malformation（ CARM） after colostomy. Methods A study involved 24 children with CARM in Jiangxi Children＇s hospital between the April 2015 and the March 2017. Of the 24 cases,17 were high-intermediate CARM,3 were low,and4 were cloacal malformations. All patients were examined by the conventional pelvic MRI and the MRI distal colostogram,and rectal morphology was analyzed with regards to the presence or absence of fistulae,length and course of fistulas. These were statistically analyzed by χ-2 test. Results By the exploration of the operation,24 cases of children with CARM after colostomy had fistulas,in 17 cases of high-intermediate ARM,1 case had bladder-neck fistula,11 cases recto-urethral prostatic fistulas,4 cases recto-urethral bulbar fistulas,1 case rectovaginal fistula; in 3 cases of low ARM,1 case rectovestibular fistula,2 cases rectoperineal fistula; 4 cases of cloacal short malformation（ 3 cm）. Of 24 patients with the CARM,5 cases displayed fistulas on conventional MRI,19 cases did not display fistulas. On MRI distal colostogram,21 cases displayed fistulas and 3 cases did not. The diagnostic accuracy rate of the conventional MRI was 20. 83%（ 5/24）,the diagnostic accuracy rate of MRI distal colostogram was 87. 5%（ 21/24）,and there were statistically significant differences ﹙ χ-2=21. 483,P〈0. 01 ﹚. Conclusion As illustrated by the current study,compared with conventional MRI,MRI distal colostogram has high clinical values for the CARM with fistulas,can aid in understanding the rectal morphology,the presence or absence of a fistulas,length and course of fistulas in patients with the CARM after colostomy,provide more detailed information for selection of surgical procedures and also prevent from postoperative complications.