發(fā)布時間：2018-02-13 16:54

  本文關鍵詞： 肛瘺 磁共振 分類 分級　出處：《福建中醫(yī)藥大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的和意義：研究MRI對肛瘺的診斷價值,初步探討MRI的肛瘺影像學分類及分級,填補國內肛瘺影像學分類分級空缺,為肛瘺的術前診斷提供更為直觀、實用、全面的參考依據(jù)。研究方法：選擇2014年1月-2014年12月在我院肛腸科診為皆有肛旁腫痛并有分泌物流出的患者150例,其中：男136例,女14例,年齡14-72歲,平均年齡38.7歲,采用SIEMENS Avanto 1.5T或Verio 3.0T超導磁共振進行術前檢查,掃描序列包括橫斷位T1WI、T2WI-FS、DWI,矢狀位、冠狀位T2WI-FS,其中48例行釓劑T1WI-FS橫斷位、矢狀位及冠狀位動態(tài)增強掃描。將手術結果與術前MRI診斷進行兩兩配對比較,觀察MRI對肛瘺內口、瘺管的診斷價值,從中篩選出真陽性病例,以現(xiàn)代肛管直腸解剖、生理病理學及臨床為基礎,參照1976年Parks肛瘺分型、2002年中華中醫(yī)藥學會肛腸分會肛瘺分類,結合圣詹姆斯大學醫(yī)院、弗萊堡大學醫(yī)院提出的肛瘺MRI分級,將真陽性肛瘺病例分為低位單純型、低位復雜型、高位單純型、高位復雜型四組,初步探討MRI的肛瘺影像學分類及分級。結果：MRI對肛瘺內口診斷的準確率、敏感性、特異性分別為93.33%、97.45%、78.13%,P=0.206;MRI對肛瘺瘺管診斷的準確率、敏感性、特異性分別91.33%、95.72%、75.76%,P=0.244。150例中真陽性患者108例,對其進一步分類分級結果可分為4大類14小類8級,具體為低位單純型24例(占22.22%)：線性括約肌間瘺(Ⅰ級)11例(10.19%),經括約肌瘺(Ⅲ級)4例(3.71%),肛門會陰瘺(Ⅵ級)9例(8.33%);低位復雜型19例(占17.59%)：線性括約肌間瘺伴膿腫或繼發(fā)瘺道(Ⅱ級)4例(3.71%),經括約肌瘺伴膿腫或繼發(fā)瘺道(Ⅳ級)7例(6.48%),馬蹄形括約肌間瘺(Ⅳ級)5例(4.63%),肛門會陰瘺3例(Ⅶ級)(2.78%);高位單純型10例(占9.26%)：線性括約肌上瘺(V級)10例(9.26%)；高位復雜型55例(50.93%)：經肛提肌瘺伴膿腫或繼發(fā)瘺道(Ⅵ級)21例(19.44%),馬蹄形經肛提肌瘺(Ⅵ級)15例(13.89%),肛提肌外瘺伴盆腔內多發(fā)膿腫(Ⅶ級)8例(7.40%),肛管-骶尾部瘺(Ⅷ級)7例(6.48%),肛管大腿瘺(Ⅷ級)2例(1.85%),肛管會陰瘺(Ⅷ級)2例(1.85%)。結論：磁共振成像對肛瘺診斷具有十分重要的價值,將肛瘺進行4大類14小類8級的影像學分類、分級,更準確、直觀、全面,為臨床術前診斷提供更為有利的依據(jù)。有助于臨床制定合理的治療方案和監(jiān)控治療,減少因診療不足引起的復發(fā)率及二次手術。
[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，

本文編號：1508638