肛瘘影像学分类及分级初探

发布时间：2018-02-13 16:54

  本文关键词： 肛瘘 磁共振 分类 分级　出处：《福建中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的和意义：研究MRI对肛瘘的诊断价值,初步探讨MRI的肛瘘影像学分类及分级,填补国内肛瘘影像学分类分级空缺,为肛瘘的术前诊断提供更为直观、实用、全面的参考依据。研究方法：选择2014年1月-2014年12月在我院肛肠科诊为皆有肛旁肿痛并有分泌物流出的患者150例,其中：男136例,女14例,年龄14-72岁,平均年龄38.7岁,采用SIEMENS Avanto 1.5T或Verio 3.0T超导磁共振进行术前检查,扫描序列包括横断位T1WI、T2WI-FS、DWI,矢状位、冠状位T2WI-FS,其中48例行钆剂T1WI-FS横断位、矢状位及冠状位动态增强扫描。将手术结果与术前MRI诊断进行两两配对比较,观察MRI对肛瘘内口、瘘管的诊断价值,从中筛选出真阳性病例,以现代肛管直肠解剖、生理病理学及临床为基础,参照1976年Parks肛瘘分型、2002年中华中医药学会肛肠分会肛瘘分类,结合圣詹姆斯大学医院、弗莱堡大学医院提出的肛瘘MRI分级,将真阳性肛瘘病例分为低位单纯型、低位复杂型、高位单纯型、高位复杂型四组,初步探讨MRI的肛瘘影像学分类及分级。结果：MRI对肛瘘内口诊断的准确率、敏感性、特异性分别为93.33%、97.45%、78.13%,P=0.206;MRI对肛瘘瘘管诊断的准确率、敏感性、特异性分别91.33%、95.72%、75.76%,P=0.244。150例中真阳性患者108例,对其进一步分类分级结果可分为4大类14小类8级,具体为低位单纯型24例(占22.22%)：线性括约肌间瘘(Ⅰ级)11例(10.19%),经括约肌瘘(Ⅲ级)4例(3.71%),肛门会阴瘘(Ⅵ级)9例(8.33%);低位复杂型19例(占17.59%)：线性括约肌间瘘伴脓肿或继发瘘道(Ⅱ级)4例(3.71%),经括约肌瘘伴脓肿或继发瘘道(Ⅳ级)7例(6.48%),马蹄形括约肌间瘘(Ⅳ级)5例(4.63%),肛门会阴瘘3例(Ⅶ级)(2.78%);高位单纯型10例(占9.26%)：线性括约肌上瘘(V级)10例(9.26%)；高位复杂型55例(50.93%)：经肛提肌瘘伴脓肿或继发瘘道(Ⅵ级)21例(19.44%),马蹄形经肛提肌瘘(Ⅵ级)15例(13.89%),肛提肌外瘘伴盆腔内多发脓肿(Ⅶ级)8例(7.40%),肛管-骶尾部瘘(Ⅷ级)7例(6.48%),肛管大腿瘘(Ⅷ级)2例(1.85%),肛管会阴瘘(Ⅷ级)2例(1.85%)。结论：磁共振成像对肛瘘诊断具有十分重要的价值,将肛瘘进行4大类14小类8级的影像学分类、分级,更准确、直观、全面,为临床术前诊断提供更为有利的依据。有助于临床制定合理的治疗方案和监控治疗,减少因诊疗不足引起的复发率及二次手术。
[Abstract]:Objective and significance: to study the value of MRI in the diagnosis of anal fistula, to explore the imaging classification and classification of anal fistula in MRI, to fill the gaps in imaging classification of anal fistula in China, and to provide a more intuitive and practical method for the preoperative diagnosis of anal fistula. Methods: from January 2014 to December 2014, 150 patients with perianal swelling and pain and discharge of secretions were selected, including 136 males and 14 females, aged 14-72 years, with an average age of 38.7 years. SIEMENS Avanto 1.5T or Verio 3.0T superconducting magnetic resonance imaging was performed before operation. The scanning sequences included T _ 1WI _ I T2WI-FSI DWI, sagittal and coronal T _ 2WI-FSs, 48 of which were performed gadolinium T1WI-FS transection. Dynamic contrast-enhanced scan in sagittal position and coronal position. The results of operation were compared with MRI diagnosis before operation. The diagnostic value of MRI in anal fistula was observed. The true positive cases were screened out from the diagnosis, and the modern anorectal anatomy was used. On the basis of physiology, pathology and clinic, according to the Parks anal fistula classification in 1976, the anal fistula classification of the Chinese Academy of traditional Chinese Medicine in 2002, combined with the MRI classification of anal fistula proposed by St. James University Hospital and Freiburg University Hospital. The patients with true positive anal fistula were divided into four groups: low simple type, low complex type, high simple type and high complex type. The imaging classification and classification of anal fistula in MRI were preliminarily discussed. The accuracy and sensitivity of MRI in the diagnosis of anal fistula and fistula were 93.33 and 97.45 respectively. The specificity of MRI was 91.33 and 95.72 respectively. 108 cases were true positive. The results of further classification and classification can be divided into 4 categories, 14 small, 8 grades. 24 cases of low simple type (22.2222%): linear sphincter fistula (grade 鈪，

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