3.0T MR在诊断复杂性肛瘘的临床价值

The Clinical Value of 3.0T MR in the Diagnosis of Complex Anal Fistula

目的:探讨3.0T MR在诊断复杂性肛瘘的临床价值。方法:选取2018年1月~2021年5月收治的复杂性肛瘘患者60例,均经手术病理证实,并行3.0T MR检查。对比60例研究对象的术前MRI表现,分析3.0T MR诊断复杂性肛瘘的临床价值。结果:60例行3.0T MRI检查的复杂性肛瘘患者中,56例可清晰显示内口、主瘘管和分支瘘管,另有肛周脓肿20例。进一步对图像进行Parks分类,经括约肌肛瘘20例,括约肌外肛瘘25例,括约肌上肛瘘15例。MRI检查诊断共可见瘘管138条,瘘口159个,肛周脓肿20例。经术后探查,共发现瘘管138条,瘘口165个,肛周脓肿20例。使用Kappa分析对所有患者瘘管接受MRI检查结果与手术探查结果的一致性比较,结果显示Kappa=1,MRI检查结果与手术探查结果对瘘管的一致性极好。对所有患者瘘口接受MRI检查结果与手术探查结果的一致性比较,结果显示Kappa=0.565,MRI检查结果与手术探查结果对瘘口的一致性较好。结论:3.0T MR能够对复杂性肛瘘的瘘管走行、内口位置进行较为准确的显示,有助于医务人员判断肛瘘数目以及瘘管和周围肌肉组织的关系,提高手术治疗的精准度。此外,3.0T MR对复杂性肛瘘是否并发肛周脓肿也有较好的显示,能够为外科手术治疗提供指导,具有重要临床价值。

Objective:To investigate the clinical value of complex anal fistula diagnosis by 3.0T MR.Methods:A total of 60 patients with complicated anal fistula admitted from January 2018 to May 2021 were selected.All patients were confirmed by surgery and pathology,and 3.0T MR examination was performed.The preoperative MRI manifestations of 60 subjects were compared to analyze the clinical value of 3.0T MR in the diagnosis of complex anal fistula.Results:Among 60 patients with complex anal fistula who underwent 3.0T MRI examination,56 cases could clearly show internal orifice,main fistula and branch fistula,and 20 cases had perianal abscess.The images were further classified by Parks,including 20 cases of transsphincteric anal fistula,25 cases of extrashincteric anal fistula,and 15 cases of supra sphincteric anal fistula.There were 138 fistulas,159 fistulas and 20 cases of perianal abscess.138 fistulas,165 fistulas and 20 cases of perianal abscess were found after operation.Kappa analysis was used to compare the consistency between the results of MRI examination and the results of surgical exploration for all patients'fistulas.The results showed that kappa=1,and the consistency between the results of MRI examination and surgical exploration for fistulas was excellent.The consistency between the results of MRI examination and the results of surgical exploration was compared for the fistula of all patients.The result showed that kappa=0.565,and the consistency between the results of MRI examination and surgical exploration was better.Conclusion:3.0T MR can accurately display the path and position of fistula in complex anal fistula,which is helpful for medical personnel to judge the number of anal fistula and the relationship between fistula and surrounding muscle tissue,and improve the accuracy of surgical treatment.In addition,3.0T MR also has a good indication of complicated anal fistula complicated by perianal abscess,which can provide guidance for surgical treatment and has important clinical value.