360°腔内联合肛周超声对比Goodsall规律在肛瘘内口定位中的价值
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摘要
目的评估360°腔内联合肛周超声在肛瘘内口定位中的应用价值,并判断其与手术结果及Goodsall规律的相关性。方法对157例原发性肛瘘患者行经会阴高频超声及360°腔内超声检查,记录主瘘管(直管型或弯管型)、外口和内口的位置,并与手术结果及Goodsall规律进行比较。结果联合超声评估内口符合率为96.2%,Goodsall规律评估内口的符合率为76. 4%,两者比较,差异有统计学意义(P <0. 05)。Goodsall规律评估不同性别患者内口符合率比较,差异有统计学意义(P<0.05)。结论 Goodsall规律在女性肛管前方位置的瘘管内口判定中作用有限,经会阴高频超声结合360°腔内超声可准确评估肛管前后方瘘管内口并指导手术方案的制定。
Objective To evaluate the value of 360° intracavitary combined with perianal ultrasound in the positioning of the internal opening of anal fistula, and determine its correlation with surgical outcomes and Goodsall rule. Methods A total of 157 patients with primary anal fistula were examined by high-frequency perineal ultrasonography combined with 360°intracavitary ultrasonography. The positions of main fistula(straight or elbow), external ostium and internal ostium were recorded and compared with the surgical results and Goodsall rule. Results The coincidence rate of combined ultrasound and Goodsall rule was 96.2% and 76.4% respectively, and there was significant difference between the two methods(P<0.05). There was significant difference in the coincidence rate of Goodsall rule in evaluating the internal ostium of patients of different genders(P <0.05). Conclusion The Goodsall rule has a limited role in the front position determination of internal ostium of the female anal canal. The high frequency ultrasound combined with 360° intracavitary ultrasound can accurately evaluate the anterior and posterior sacral canal and guide the surgical plan.
Objective To evaluate the value of 360° intracavitary combined with perianal ultrasound in the positioning of the internal opening of anal fistula, and determine its correlation with surgical outcomes and Goodsall rule. Methods A total of 157 patients with primary anal fistula were examined by high-frequency perineal ultrasonography combined with 360°intracavitary ultrasonography. The positions of main fistula(straight or elbow), external ostium and internal ostium were recorded and compared with the surgical results and Goodsall rule. Results The coincidence rate of combined ultrasound and Goodsall rule was 96.2% and 76.4% respectively, and there was significant difference between the two methods(P<0.05). There was significant difference in the coincidence rate of Goodsall rule in evaluating the internal ostium of patients of different genders(P <0.05). Conclusion The Goodsall rule has a limited role in the front position determination of internal ostium of the female anal canal. The high frequency ultrasound combined with 360° intracavitary ultrasound can accurately evaluate the anterior and posterior sacral canal and guide the surgical plan.
引文
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[3]CUINAS K,WILLIAMS JG.PTU-196 Goodsall's rule-past its sell-by date?[J].Gut,2015,64(Suppl 1):A149.2-A149.
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[6]MURAD-REGADAS SM,REGADAS FS,R LV,et al.The role of 3-dimensional anorectal ultrasonography in the assessment of ante rior transsphincteric fistula[J].Dis Colon Rectum,2010,53(7):1035-1040.
[7]JAYARAJAH U,SAMARASEKERA DN.Predictive accuracy of Goodsall's rule for fistula-in-ano[J].Ceylon Med J,2017,62(2):97-99.
[8]CIROCCO WC,REILLY JC.Challenging the predictive accuracy of Goodsall's rule for anal fistulas[J].Dis Colon Rectum,1992,35(6):537-542.
[9]BUCHANAN GN,HALLIGAN S,BARTRAM CI,et al.Clinical examination,endosonography,and MR imaging in preoperative assessment of fistula in ano:comparison with outcome-based reference standard[J].Radiology,2004,233(3):674-681.
[10]SUN Y,CUI L,LIU J,et al.Utility of 360°real-time endoanal sonography for evaluation of perianal fistulas[J].J Ultrasound Med,2017,37(1):93-98.
[2]MURAD-REGADAS SM,DEALCANFREITAS ID,PESSOA MORA-NO D,et al.Anatomical characteristics of anal fistula evaluated by three-dimensional anorectal ultrasonography:is there a correlation with Goodsall's theory?[J].J Coloproctol,2015,35(2):83-89.
[3]CUINAS K,WILLIAMS JG.PTU-196 Goodsall's rule-past its sell-by date?[J].Gut,2015,64(Suppl 1):A149.2-A149.
[4]CHO D.Endosonographic criteria for an internal opening of fistulain-ano[J].Dis Colon Rectum,1999,42(4):515-518.
[5]BECK DE.The ASCRS manual of colon and rectal surgery 2014[M]//The ASCRS manual of colon and rectal surgery.Springer New York,2014:643-644.
[6]MURAD-REGADAS SM,REGADAS FS,R LV,et al.The role of 3-dimensional anorectal ultrasonography in the assessment of ante rior transsphincteric fistula[J].Dis Colon Rectum,2010,53(7):1035-1040.
[7]JAYARAJAH U,SAMARASEKERA DN.Predictive accuracy of Goodsall's rule for fistula-in-ano[J].Ceylon Med J,2017,62(2):97-99.
[8]CIROCCO WC,REILLY JC.Challenging the predictive accuracy of Goodsall's rule for anal fistulas[J].Dis Colon Rectum,1992,35(6):537-542.
[9]BUCHANAN GN,HALLIGAN S,BARTRAM CI,et al.Clinical examination,endosonography,and MR imaging in preoperative assessment of fistula in ano:comparison with outcome-based reference standard[J].Radiology,2004,233(3):674-681.
[10]SUN Y,CUI L,LIU J,et al.Utility of 360°real-time endoanal sonography for evaluation of perianal fistulas[J].J Ultrasound Med,2017,37(1):93-98.