后盆底肛周感染的MRI定位初探
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摘要
目的基于最新的肛部MRI解剖研究成果,探索一种后盆底肛周感染的新定位系统。方法肛部被分为4区。A区位于肛提肌的内侧和上方;B区位于肛提肌的外侧和下方;C区位于中央间隙(肛门平滑肌和肛门外括约肌之间的脂肪间隙),此处肛提肌尾端变成了一系列腱索,导致A区和B区在C区直接连通;S区为肛管黏膜下间隙。依据脓肿和肛瘘的位置,92例患者被计数和分类。结果 92例患者中共发现93处脓肿和肛瘘病灶,与C区有关的感染灶71处,与C区无关者22处,C区通过肌间隙扩散65处,其中与B区通过肛提肌外侧间隙及肛门外括约肌深部、浅部间肌间隙沟通者60处,占92.3%,C区向上通过肛提肌内侧间隙与A区沟通者5处,占7.7%,C区感染灶通过外括约肌和/或耻骨直肠肌累及B区者14例。结论使用全部肛门肌肉和肛周间隙作为界标,可以为外科医生做出一个更精确的肛周感染的定位,指导制定更合理的治疗方案。
Objective To explore a new grading system of perianal infection in posterior pelvic floor based on the newest magnetic resonance imaging(MRI) anatomy of anal region. Methods Anal region was subdivided into 4 areas and 12 zones based on all anal muscles and all perianal spaces. Area A is above the levator ani muscle. Area B is below the levator ani muscle. Area C is located in the center space, where the caudal end of the levator ani muscle becomes a series of tendinous cords, resulting in a group of direct channels linking area A and area B at area C. S is submucosal space.Ninety-two patients were counted and classified depending on the location of perianal abscess or fistula. Results There were 93 foci of infection in 92 patients. Seven-one foci were related to C area, and twenty-two foci were not related to C area. There were 65 foci spreading through spatium intermusculare, of which 60 foci were connecting with area B, 5 foci connecting with area A. There were 14 foci spreading through external anal sphincter and/or puborectalis. Conclusion It can make a precise location of perianal infection for surgeons using all anal muscles and all perianal spaces as the landmarks.
Objective To explore a new grading system of perianal infection in posterior pelvic floor based on the newest magnetic resonance imaging(MRI) anatomy of anal region. Methods Anal region was subdivided into 4 areas and 12 zones based on all anal muscles and all perianal spaces. Area A is above the levator ani muscle. Area B is below the levator ani muscle. Area C is located in the center space, where the caudal end of the levator ani muscle becomes a series of tendinous cords, resulting in a group of direct channels linking area A and area B at area C. S is submucosal space.Ninety-two patients were counted and classified depending on the location of perianal abscess or fistula. Results There were 93 foci of infection in 92 patients. Seven-one foci were related to C area, and twenty-two foci were not related to C area. There were 65 foci spreading through spatium intermusculare, of which 60 foci were connecting with area B, 5 foci connecting with area A. There were 14 foci spreading through external anal sphincter and/or puborectalis. Conclusion It can make a precise location of perianal infection for surgeons using all anal muscles and all perianal spaces as the landmarks.
引文
[1] Maolin Guo, Chunfang Gao, Dawei Li, et al. MRI anatomy of the anal region [J]. Diseases of the Colon and Rectum, 2010, 53(11): 1542-1548.
[2] Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VII. Anal fistula: a simplified classification [J]. Dis Colon Rectum, 1979, 22(6): 408-414.
[3] Milligan ET, Morgan CN. Surgical anatomy of the anal canal with special reference to anorectal fistulae [J]. Lancet, 1934, 224(4): 1213-1217.
[4] Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano [J]. Br J Surg, 1976, 63(1): 1-12.
[5] 杨柏霖,古云飞,祝新,等.磁共振成像在复杂性肛瘘诊断中的应用[J].中华胃肠外科杂志,2008,11(4):339-342.
[6] 左志贵,宋华羽,倪士昌.多层螺旋CT结合瘘管造影在肛瘘诊治中的应用[J].中国肛肠病杂志,2007,27(5):11-16.
[7] Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VI. The central abscess: a new clinicopathologic entity in thegenesis of anorectal suppuration [J]. Dis Colon Rectum, 1979, 22(5): 336-341.
[2] Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VII. Anal fistula: a simplified classification [J]. Dis Colon Rectum, 1979, 22(6): 408-414.
[3] Milligan ET, Morgan CN. Surgical anatomy of the anal canal with special reference to anorectal fistulae [J]. Lancet, 1934, 224(4): 1213-1217.
[4] Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano [J]. Br J Surg, 1976, 63(1): 1-12.
[5] 杨柏霖,古云飞,祝新,等.磁共振成像在复杂性肛瘘诊断中的应用[J].中华胃肠外科杂志,2008,11(4):339-342.
[6] 左志贵,宋华羽,倪士昌.多层螺旋CT结合瘘管造影在肛瘘诊治中的应用[J].中国肛肠病杂志,2007,27(5):11-16.
[7] Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VI. The central abscess: a new clinicopathologic entity in thegenesis of anorectal suppuration [J]. Dis Colon Rectum, 1979, 22(5): 336-341.