复发性肛瘘的MR影像学特征

MR Imaging Features of Recurrent Anal Fistula

目的 探讨复发性肛瘘的MR影像学特征及规律。方法 将本研究29例患者首次手术前、二次手术前所行磁共振平扫+增强扫描检查影像资料分别设定为对照组、研究组,分别与首次及二次手术结果对照其瘘口、瘘管显示的准确率,肛瘘分型的一致性,并回顾性对比分析MR的影像特点。结果 对照组、研究组的内口、主瘘管及支管的显示准确率均较高,分别为91.1%、95.2%、90.3%,95.0%、97.3%、88.0%。对照组、研究组MR术前分型与手术分型的一致性均良好,Kappa值分别为0.891、0.929(按Parks分型),0.946、0.949(按瘘管数目和位置高低分型)。与对照组对比,研究组中:内口位置均不高于原内口位置,均无明显肛周脓肿形成;大多数瘘管形态变细、周围炎性浸润范围变小、瘢痕形成、无明显肛门括约肌功能受损;部分瘘管支数变少、长度变短、分型趋于简单化。结论 MR能较好完成初诊及复发性肛瘘的术前评估,本研究中大部分复发性肛瘘的MR观察项目呈不同程度向好趋势,具有一定的MR影像学特征及规律。

Objective To explore the features and rules of recurrent anal fistula in MR images. Methods Will this study for the first time in 29 cases before the operation,secondly surgery before MRI enhanced scan image data were set as control group,research group. Respectively with the first and second operation against the fistula. Fistula results indicate the accuracy,consistently of anal fistula classification,and characteristics of retrospective analysis of MRI images. Results The accuracy of inner orifices,main fistulas and branch tubes in the control group and study group were 91.1%,95.2%,90.3%,95.0%,97.3% and 88.0%.The consistency of Preoperative and operative MRI typing was good in both the control group and the study group,and the Kappa values were 0.891 and 0.929(Parks classification);0.946 and 0.949(according to the number and location of the fistula).Compared with the control group,the internal orifice position in the study group was not higher than the original internal orifice position,and there was no obvious perianal abscess formation.Most of the fistulas became thinner,the area of inflammatory infiltration became smaller,scar formation,and no significant anal sphincter function impairment.The number and length of partial fistulas were reduced,and the classification tended to be simplified. Conclusions MR can complete the first diagnosis and preoperative assessment of the recurrent anal fistula.In this study,most MRI observation items of recurrent anal fistulas showed a positive trend to varying degrees,with certain MRI imaging characteristic and rules.