经瘘管超声造影在肛瘘诊断中的应用

Diagnostic value of trans-fistula contrast-enhanced ultrasound in anal fistula

目的探讨经瘘管超声造影在肛瘘诊断中的应用价值。方法选取2016年2月至2017年12月宁波市第二医院肛肠科收治的98例患者,分别行常规超声与经瘘管超声造影检查。记录肛瘘瘘管的走行及其与括约肌和肛提肌的关系(Parks分类),分支瘘管的数目,内口的数目、位置、距肛缘距离,并与手术诊断结果作对照分析。结果经瘘管超声造影诊断肛瘘Parks分类的准确性高于常规超声检查(90.82%vs 80.61%),差异有统计学意义(χ2=4.167,P=0.041)。经瘘管超声造影诊断分支瘘管的准确性低于常规超声检查(81.08%vs 86.49%),差异无统计学意义(χ2=0.400,P> 0.05)。经瘘管超声造影诊断肛瘘内口的准确性为92.68%,常规超声诊断内口的准确性为78.05%,差异有统计学意义(χ2=10.543,P=0.001)。结论经瘘管超声造影对肛瘘Parks分类的诊断及内口的判断具有较高的准确性,可弥补常规超声的不足,为临床治疗决策提供依据。

Objective To assess the clinical value of trans-fistula contrast-enhanced ultrasound(CEUS)in diagnosing anal fistula.Methods An analysis was performed of98patients with anal fistula who underwent conventional ultrasound and trans-fistula CEUS from February2016to December2017.We recorded the following parameters:fistulous trend and its positional relation with levator ani muscle and sphincter(Parks classification);the number of fistulous branches;the number of fistulas,the position of fistula,and the distance between fistulous internal opening and anal edge.Then,we compared these parameters with surgical diagnostic results.Results The accuracy of Parks classification performed by trans-fistula CEUS was significantly higher than that of conventional ultrasound(90.82%vs80.61%,χ^2=4.167,P=0.041).The accuracy of trans-fistula CEUS in the diagnosis of branch fistula was lower than that of conventional ultrasonography(81.08%vs86.49%),but there was no significant difference(χ^2=0.400,P>0.05).The accuracy of trans-fistula CEUS was significantly higher than that of conventional ultrasonography(92.68%vs78.05%,χ^2=10.543,P=0.001).Conclusion Trans-fistula CEUS has a high accuracy in the Parks classification and in the judgment of the internal orifice of anal fistula.It can make up for the deficiency of conventional ultrasonography and provide a basis for clinical treatment decision-making.