术前三维肛管直肠腔内超声检查对肛瘘手术的疗效分析

Curative effect of preoperative three-dimensional anorectal endosonography in analfistula surgery

目的探讨术前三维肛管直肠腔内超声(3D-AREUS)检查对肛瘘手术疗效的影响。方法前瞻性纳入2017年12月至2018年12月期间朝阳市中心医院结直肠肛门外科连续收治的诊断明确且拟行手术的100例肛瘘患者,采用计算机产生随机号的方法随机分为超声组和对照组,每组50例。超声组术前采用3D-AREUS检查,对照组术前常规检查、采用指诊或探针探查,比较2组术后复发率及手术前后肛门功能(Wexner失禁评分、直肠肛管压力)变化情况。结果超声组和对照组患者性别、年龄、体质量指数、肛门手术史、术前肛门功能等基线资料比较差异无统计学意义(P>0.05)。超声组发现分支瘘管率高于对照组(P=0.025)。内口定位准确率在简单性肛瘘患者的超声组和对照组间比较差异无统计学意义(P=0.635),而其在复杂性肛瘘患者的超声组高于对照组(P=0.014)。手术前后大便失禁评分变化值在简单性肛瘘患者的超声组和对照组间比较差异无统计学意义(P=0.194),而其在复杂性肛瘘患者的超声组低于对照组(P=0.039)。手术前后肛瘘肛管静息压、肛管收缩压、肛管高压区长度变化值在简单性肛瘘患者的超声组和对照组间比较差异无统计学意义(P>0.05),而其在复杂性肛瘘患者的超声组均低照组(P<0.05)。2组术后各有4例患者出现复发。结论对于复杂性肛瘘,术前行3D-AREUS检查可以明确内口位置、发现是否存在分支瘘管以及瘘管走行与括约肌的关系,便于制定精准手术方案、减少副损伤及保留患者术后肛门功能。

Objective To investigate effect of preoperative three-dimensional anorectal endosonography(3D-AREUS)in anal fistula surgery.Methods A total of 100 patients with anal fistula who were admitted to the Chaoyang Central Hospital from December 2017 to December 2018 were included prospectively,then were randomly divided into ultrasound group and control group with 50 cases in each group.The preoperative examination was performed by 3D-AREUS in the ultrasound group,and preoperative routine examination,finger examination or probe exploration were performed in the control group.The postoperative recurrence and anal functions were compared between the two groups.Results There were no statistically significant differences in the gender,age,body mass index,anal surgery history,preoperative anal function,etc.between the two groups(P>0.05).The detection rate of branch fistulas in the ultrasound group was significantly higher than that in the control group(P=0.025).For the patients with complex anal fistula,compared with the control group,the location accuracy rate of internal opening was higher(P=0.014),the change value of preoperative and postoperative fecal incontinence score was lower(P=0.039),anorectal pressure status(resting pressure of anal canal,anal systolic pressure,and length of anal high pressure zone)were lower(P<0.05)in the ultrasound group;For the patients with simple anal fistula,which had no significant differences between the ultrasound group and control group(P>0.05).There were 4 cases of recurrence in each group.Conclusions For complex anal fistula,preoperative 3D-AREUS could clarify position of internal opening,presence of branching fistula,and the relationship between fistula and sphincter,so as to make accurate surgical plans,reduce secondary injuries,and retain postoperative anal function of patients.