经肛周三维超声对肛瘘诊断价值的研究

摘要

目的：探讨经肛周三维超声检查在肛瘘诊断中的应用价值。方法术前对39例肛瘘患者分别行经肛周高频联合经直肠双平面超声和经肛周三维超声检查，以手术结果为金标准，分析并比较2种检查方法对肛瘘的诊断价值。结果经肛周高频联合经直肠双平面二维超声检查均能充分显示39例患者的病灶，进行有效评估；经肛周三维超声因受扫查深度和观察范围不足影响而未能对2例（2／9）高位肛瘘及5例（27．8％）复杂性肛瘘患者进行有效评估。经肛周三维超声检查对内口、瘘管、合并脓肿的探查情况及分型比经肛周高频联合经直肠双平面超声检查的符合率稍低，分别为82．1％ vs．87．2％、82．1％ vs．92．3％、64．1％ vs．76．9％及82．1％ vs．92．3％，但比较差异均无统计学意义（P 均＞0．05）。2种方法对低位和高位肛瘘以及单纯性和复杂性肛瘘在内口、瘘管、合并脓肿及分型方面的诊断符合率比较差异均无统计学意义（P 均＞0．05）。经肛周三维超声检查可以形象地显示肛瘘整体观，可以得到二维图像难以得到的 C 平面。三维表面成像及断层超声成像模式多层面显像可以连续追踪观察瘘管的走行。结论经肛周三维超声检查能直观地评估肛瘘情况，尤其适用于低位及单纯性肛瘘，但因受扫查深度和范围等的影响使其对部分高位和复杂性肛瘘的评估受限。肛周三维超声检查可作为经肛周高频联合经直肠双平面超声的备用检查方式。%Objective To evaluate the clinical value of trans-anal three-dimensional ultrasound in di-agnosis of anal fistula.Methods Thirty nine patients diagnosed with anal fistula received trans-anal high-fre-quency linear probe combined with transrectal biplane ultrasound and trans-anal three-dimensional ultrasound before surgery.Surgical outcomes were considered as gold standard.The diagnostic value between two methods was statistically compared.Results By using trans-anal high-frequency linear probe combined with transrectal biplane ultrasound,anal fistula could be identified and assessed in all 39 patients.Due to insufficient depth and limited range of three-dimensional trans-anal ultrasound,two cases (2 /9)with high anal fistula and five (27.8%)with complex anal fistula were not effectively evaluated.The consistency rate of trans-anal three-di-mensional ultrasound in the assessment of internal opening (82.1% vs.87.2%),fistula tract (82.1%vs.92.3%),abscess complication(64.1% vs.76.9%),typing of fistula(82.1% vs.92.3%)were slightly lower compared with those of high-frequency linear probe combined with transrectal biplane ultrasound with no statistical significance (all P >0.05).The consistency rate in the evaluation of internal opening,fistula tract, abscess complication,typing of fistula between low and high,simple and complex fistula did not significantly differ between two approaches (all P >0.05).Trans-anal three-dimensional ultrasound could explicitly reveal the appearance of anal fistula and yield plane C that two dimensional ultrasound failed to obtain.Three dimen-sional surface imaging and multi-planar tomographic ultrasound could continuously monitor the track of fistula tract.Conclusions Trans-anal three-dimensional ultrasound can directly reveal the anal fistula,especially for low and simple anal fistula.Due to the limited depth and range of probe scanning,it fails to accurately evaluate the high and complex anal fistula.Therefore,trans-anal three-dimensional ultrasound could be used as an alter-native option for trans-anal high-frequency linear probe combined with transrectal biplane ultrasound as necessa-ry.