MRI检查在复杂性肛瘘诊断中的应用价值

Application value of MRI examination in the diagnosis of complex anal fistula

目的 探讨MRI检查在复杂性肛瘘诊断中的应用价值。方法 回顾性分析2020年1月至2020年12月南京中医药大学附属苏州市中医医院肛肠科收治的62例复杂性肛瘘患者的临床资料,所有患者均于手术前一周行MRI检查,以术中探查结果为基准,对比分析MRI诊断复杂性肛瘘的准确率。结果 62例患者中,MRI检查共发现主瘘管71支、内口67个、分支瘘管24支,伴发脓肿15例。依据Parks分型,MRI检查诊断括约肌上型肛瘘4例、括约肌间型肛瘘42例、括约肌外型肛瘘2例、经括约肌型肛瘘14例。术中探查明确主瘘管71支、内口68个、分支瘘管26支,伴发脓肿15例,括约肌上型肛瘘6例、括约肌间型肛瘘46例、括约肌外型肛瘘2例、经括约肌型肛瘘17例。以术中探查为基准,MRI检查检出主瘘管、内口、分支瘘管及脓肿的准确率分别为100%、98.5%、92.3%、100%,诊断复杂性肛瘘Parks分型的准确率分别为66.7%、91.3%、100%、82.4%。结论 术前MRI检查对复杂性肛瘘的主瘘管、分支瘘管、内口及脓肿的诊断准确率较高,而对肛瘘Parks分型的诊断存在一定的误差,尤其是对括约肌上型肛瘘。

Objectives To investigate the application value of MRI examination in the diagnosis of complex anal fistula.Meth-ods A retrospective analysis was conducted on the clinical data of 62 patients with complex anal fistula admitted to the Depart-ment of Proctology,Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine from January 2020 to December 2020.All patients underwent MRI examination one week before surgery.Taking the intraoperative exploration results as the refer-ence,the accuracy of MRI in diagnosing complex anal fistula was compared and analyzed.Results Among the 62 patients,MRI examination showed 71 main fistulas,67 internal openings,24 branch fistulas,and 15 patients with abscesses.According to the Parks Classification,4 suprasphincteric,42 intersphincteric,2 extrasphincteric,and 14 transsphincteric were diagnosed by MRI ex-amination.During intraoperative exploration,71 main fistulas,68 internal openings,26 branch fistulas,15 patients with abscess-es,6 suprasphincteric,46 intersphincteric,2 extrasphincteric,and 17 transsphincteric were confirmed.Using surgical findings as the reference standard,the accuracy rates of MRI examination were 100%,98.5%,92.3%and 100%for detecting the main fistu-la,internal stoma opening,branching fistula and abscess,respectively.The accuracy rates of Parks classification in diagnosing complex anal fistula were 66.7%,91.3%,100%and 82.4%,respectively.Conclusion Preoperative MRI examination demonstrates a high diagnostic accuracy rate for identifying the main fistula,branch fistula,internal opening and abscess of complex anal fistu-la.However,it is noteworthy that there is a degree of error in the diagnosis of the Parks Classification of anal fistula,particular-ly in the case of suprasphincteric anal fistula.