经直肠双平面超声联合经会阴部高频超声诊断肛瘘的研究

发布时间：2018-04-23 17:08

本文选题：肛瘘 + 经直肠双平面超声　；参考：《安徽中医药大学》2017年硕士论文

【摘要】：目的采用经直肠双平面超声、经会阴部高频超声及二者联合超声检查技术研究肛瘘超声影像特征,并以手术医师术中诊断为金标准,分析各种检查方法在肛瘘诊断中的诊断效果及应用价值。方法回顾性分析我院71例分别采用经会阴部高频超声、经直肠双平面超声及二者联合超声检查方式探查肛瘘的超声影像特征,并与手术医师术中诊断对照,计算不同超声诊断方式诊断肛瘘内口位置、外口位置、主瘘管数、分支瘘管数及肛瘘的分型与手术结果的符合率,分析经直肠双平面超声、经会阴部高频超声及二者联合诊断优势及缺点,总结出诊断肛瘘更有效的超声检查方法。结果(1)经会阴部高频超声检出主瘘管数、分支瘘管数、内口、外口数为92、41、35、111,经直肠双平面超声检出主瘘管、分支瘘管、内口、外口数分别为94、43、100、2,二者联合探查检出主瘘管、分支瘘管、内口、外口数分别为112、51、110、119,手术中结果证实的主瘘管数、分支瘘管数、内口、外口数为117、53、114、120。(2)对于主瘘管探查,三种不同方法对主瘘管检出率的差异总体上具有统计学意义(χ~2=16.179、P0.001)。两两比较结果显示,二者联合超声的检出率(95.73%)大于经会阴高频超声和经直肠双平面超声的检出率(两者分别为78.63%和80.34%),且差异具有统计学意义;而经会阴高频超声和经直肠双平面超声的检出率没有统计学差异。(3)对于分支瘘管检查,三种不同方法对分支瘘管检出率的差异总体上具有统计学意义(χ~2=8.244、P=0.0160.05)。两两比较结果显示,二者联合超声的检出率(96.23%)大于经会阴高频超声和经直肠双平面超声的检出率(两者分别为77.36%和81.13%),且差异具有统计学意义;而经会阴高频超声和经直肠双平面超声的检出率没有统计学差异。(4)对于内口探查,三种不同方法对内口检出率的差异总体上具有统计学意义(χ~2=143.190、P0.001)。两两比较结果显示,二者联合超声的检出率(96.49%)大于经会阴高频超声和经直肠双平面超声的检出率(两者分别为30.70%和87.72%),且差异具有统计学意义;而经直肠双平面超声的检出率(87.72%)大于经会阴高频超声的检出率(30.70%),且差异具有统计学意义。(5)对于外口探查,三种不同方法对外口检出率的差异总体上具有统计学意义(χ~2=310.757、P0.001)。两两比较结果显示,二者联合超声的检出率(99.17%)大于经会阴高频超声和经直肠双平面超声的检出率(两者分别为92.50%和1.67%),且差异具有统计学意义;而经会阴高频超声的检出率(92.50%)大于经直肠双平面超声的检出率(1.67%),且差异具有统计学意义。(6)根据肛瘘主瘘管与肛管括约肌关系判断Parks分型,(1)二者联合诊断方式超声检查括约肌间型、经括约肌型的准确率明显要比于对括约肌上型和括约肌外型肛瘘的准确率高。(2)二者联合超声诊断方式对括约肌间型和经括约肌型的检出率均为100%,且两组差异无统计学意义;二者联合超声诊断方式对这两种分型肛瘘具有极高的诊断准确率,漏诊率几乎为0%。(3)二者联合超声诊断方式对括约肌上型和括约肌外型的检出率分别为40%和0%,且两组差异无统计学意义;二者联合超声对这两种分型肛瘘诊断准确率均较低,漏诊率较高。结论经会阴部高频超声对肛瘘外口及肛瘘管肛周皮下段显示清晰,经直肠双平面超声对肛瘘内口、瘘管与括约肌关系及瘘管的肛管较深部段显示清晰,因此两种方法联合探查对于肛瘘的诊断具有更高的临床价值。
[Abstract]:Objective to study the ultrasonographic features of anal fistula by transrectal double plane ultrasound, transperineal high-frequency ultrasound and two cases combined ultrasonic examination, and to analyze the diagnostic effect and application value of various methods in the diagnosis of anal fistula with the diagnostic gold standard of the surgeons. Methods 71 cases in our hospital were analyzed retrospectively. High frequency ultrasound, transrectal double plane ultrasound and two combined ultrasonic examination were used to investigate the ultrasonographic features of anal fistula, and compared with the surgeons, and compared with the surgeons, to calculate the location of the anal fistula, the position of the external mouth, the number of main fistula, the number of fistula and the coincidence of the anus fistula and the operation results. Biplane ultrasound, with the combined diagnosis of the perineal high-frequency ultrasound and the combined diagnosis of two cases, summed up a more effective diagnostic method for the diagnosis of anal fistula. Results (1) the number of the main fistula, the number of branch fistula, the internal mouth, the number of external mouth were 92,41,35111, and the number of fistula, branch fistula, internal mouth, and the number of external mouth were detected by the transrectal high frequency ultrasound. The number of main fistula, branch fistula, internal mouth and external mouth were 112,51110119 respectively. The number of main fistula, branch fistula, internal mouth and external mouth were 117,53114120. (2) for main fistula, the difference in the detection rate of main fistula in three different methods was statistically significant (94,43100,2). X ~2=16.179, P0.001). 22 comparison results showed that the detection rate of combined ultrasound (95.73%) was greater than that of transperineal high frequency ultrasound and transrectal biplane ultrasound (78.63% and 80.34% respectively), and the difference was statistically significant, but there was no statistical difference between perineal high frequency ultrasound and transrectal biplane ultrasound. 3) for branch fistula examination, the difference in the detection rate of branch fistula in three different methods was statistically significant (x ~2=8.244, P=0.0160.05). 22 comparison results showed that the detection rate of combined ultrasound (96.23%) in two cases was greater than that of transperineal high frequency ultrasound and transrectal biplane ultrasound (77.36% and 81.13% respectively). The difference was statistically significant, but the detection rate of the transperineal high frequency ultrasound and the transrectal biplane ultrasound was not statistically significant. (4) for the internal oral exploration, the difference in the detection rate of the inner mouth of the three different methods was statistically significant (x ~2=143.190, P0.001). The 22 ratio showed that the detection rate of the two combined ultrasound (96.49%) was significant. The detection rates of transperineal high frequency ultrasound and transrectal biplane ultrasound (both 30.70% and 87.72%) were statistically significant, while the detection rate of transrectal biplane ultrasound (87.72%) was greater than that of perineum high frequency ultrasound (30.70%), and the difference was statistically significant. (5) for external exploration, three different methods were applied to the outside world. The difference in oral detection rate was statistically significant (x ~2=310.757, P0.001). 22 The results showed that the detection rate of the two combined ultrasound (99.17%) was greater than that of the transperineal high frequency ultrasound and the transrectal biplane ultrasound (92.50% and 1.67% respectively), and the difference was statistically significant; and the detection of the perineum high frequency ultrasound was a significant difference. The rate (92.50%) was greater than that of the transrectal biplane ultrasound (1.67%), and the difference was statistically significant. (6) according to the relationship between the anal fistula and the anal sphincter, the Parks classification was judged, and (1) two combined diagnostic methods were used to examine the INTERSPHINCTER type. The accuracy of the sphincter type was significantly higher than that of the sphincter type and the sphincter anal fistula. The rate of accuracy was high. (2) the detection rate of INTERSPHINCTER type and sphincter type was 100% with two combined ultrasonic diagnostic methods, and there was no significant difference between the two groups. The two combined ultrasonic diagnosis method had high diagnostic accuracy for the two types of anal fistula, and the missed diagnosis rate was almost 0%. (3) two combined ultrasound diagnosis on the upper sphincter type. The detection rates of the external sphincter and the sphincter were 40% and 0% respectively, and there was no significant difference in the two groups. The diagnostic accuracy of the two types of anal fistula was lower and the rate of missed diagnosis was higher in two cases. The relationship between sphincter and the depth of the anal canal is clear. Therefore, the combination of the two methods has a higher clinical value for the diagnosis of anal fistula.

【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R657.16

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