磁共振成像检查在肛瘘手术中的应用价值

摘要

目的 讨论磁共振成像(MRI)检查在肛瘘手术中的应用价值.方法 收集27例经手术证实为肛瘘的患者,术前均进行MRI检查,其中18例行增强扫描,扫描序列主要包括轴位T1加权成像,轴位、矢状位、冠状位脂肪抑制T2加权成像,轴位弥散成像,增强轴位、矢状位、冠状位脂肪抑制T1加权成像.将MRI检查诊断结果与手术结果进行比较.结果 27例患者中,术前MRI检查发现瘘管30条,支管8条,外口29个,内口25个,并发肛周脓肿2例.MRI对显示主瘘管和支管的准确率分别为96.8％(30/31)和88.9％(8/9),对外口显示的准确率为96.7％(29/30),对内口显示的准确率为92.6％(25/27),对脓肿显示的准确率为100％(2/2).结论 MRI检查可准确显示肛瘘,特别是复杂性肛瘘的数目、瘘管走行、支管形成及内口的位置和瘘管与周围肌肉(肛管括约肌、肛提肌)关系、有无脓肿形成,为临床手术治疗提供重要的指导信息,具有很高的应用价值.%Objective To explore the value of MRI to the diagnosis of anal fistulas. Methods 27 patients with anal fistulas operative verified were performed MRI before operation. The MR pulse sequences were performed on 18 cases. MR scan sequence included axial T1WI, T2WI with fat suppression at axial, sagittal and coronal planes, axial DWI, T1WI with fat suppression and dynamic contrast enhancement at axial, sagittal and coronal planes. MRI findings were analyzed by comparing with the surgical results. Results 27 patients were found to have 30 fistulas, 8 branch fistulas, 29 external openings, 25 internal openings, and 2 perianal abscesses by MRI before surgery. The precision for detecting fistulas, branch fistulas, external openings, internal openings and perianal abscesses were 96. 8% (30/31) , 88. 9%(8/9) , 96. 7% (29/30), 92. 6% (25/27) and 100% (2/2) respectively. Conclusion MRI can accurately present the number and the track of fistula, the location of internal opening and the relation between fistula and its surrounding composition, perianal abscesses. It provides great vale for surgical planning and operation.