肛瘘磁共振术前评估的临床价值

The Application Value of MRI in the Preoperative Evaluation of Anal Fistula

目的探讨MRI在肛周脓肿及肛瘘诊疗中的应用价值。方法选择经手术治疗的肛周脓肿和肛瘘患者49例,其中男性40例,女性9例;年龄15~74岁,平均年龄39.98岁。全部病例行MRI检查,并与手术病理结果对照,评估MRI在肛周脓肿和肛瘘诊疗中的应用价值。结果手术病理发现脓腔45个,瘘道18条,内口16个,外口25个;MRI显示脓腔48个,瘘道12条,内口10个,外口12个,两者比较(48.4%vs 51.6%、60%vs 40%、61.5%vs 38.5%、67.6%vs 32.4%,P>0.05),差异无统计学意义;手术病理证实肛周脓肿33例,肛瘘16例;MRI发现肛周脓肿39例,肛瘘10例,两者比较(67.3%vs 79.5%、32.6%vs 20.4%,P>0.05),差异无统计学意义。结论MRI因其无辐射、软组织分辨率高、多参数任意层面成像的特点在对肛瘘的影像诊断,对瘘口和瘘道位置、数目、走行及与毗邻括约肌、肛提肌组织结构关系的显示具有无可比拟的优势,并为术前评估及手术方案制定提供可靠的重要影像数据。

Objective To investigate the application value of MRI in the diagnosis and treatment of perianal abscess and anal fistula.Methods A total of 49 patients with perianal abscess and anal fistula treated by surgery were selected,including 40 males and 9 females;the age ranged from 15 to 74 years old,with an average age of 39.98 years.All cases underwent MRI examination and compared with the surgical and pathological results to evaluate the application value of MRI in the diagnosis and treatment of perianal abscess and anal fistula.Results There were 45 abscess cavities,18 fistula tracts,16 internal orifices,and 25 external orifices found by operation and pathology;MRI showed 48 abscess cavities,12 fistula tracts,10 internal orifices,and 12 external orifices.48.4%vs 51.6%,60%vs 40%,61.5%vs 38.5%,67.6%vs 32.4%,P>0.05,the difference was not statistically significant;33 cases of perianal abscess and 16 cases of anal fistula were confirmed by surgery and pathology;There were 39 cases of weekly abscess and 10 cases of anal fistula.There was no significant difference between the two(67.3%vs 79.5%,32.6%vs 20.4%,P>0.05).Conclusion Because of its non-radiation,high soft tissue resolution,and multiparameter imaging at any level,MRI is useful in the imaging diagnosis of anal fistulas,and can display the location,number,course of the fistula opening and fistula tract,and the relationship with the adjacent sphincter and levator ani tissue structure.It has unparalleled advantages and provides reliable and important imaging data support for preoperative evaluation and surgical plan formulation.