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目的探讨多层螺旋CT(MSCT)平扫、增强并结合瘘管造影对肛瘘进行定位诊断的临床应用价值。方法2004年7月至2006年5月间温州医学院附属第一医院对32例临床疑诊为肛瘘的病人使用16层螺旋CT扫描和瘘管造影。原始图像采用多平面重建(MPR)和容积重建(VR)技术进行三维重建,后处理图像由放射科专业医生完成。将术前获取的影像学资料与显微肛瘘手术和随访结果进行比较。结果MSCT上4例未发现肛瘘,5例为单纯性肛瘘,23例为复杂性肛瘘,均经过手术证实,肛肠专科检查将8例复杂性肛瘘误诊为单纯性肛瘘。MSCT上低位肛瘘6例,高位肛瘘22例,均经过手术证实,其中肛肠专科检查将8例高位肛瘘误诊为低位肛瘘,MSCT上3例括约肌外瘘误诊为括约肌上瘘。MSCT对术前内口、支管、脓腔评价的准确率分别为62.1%、89.3%、100.0%。MSCT后处理重建技术中,MPR包括曲面重建(CPR)可清晰显示瘘管的具体位置及其与肛管内外括约肌、肛提肌的关系,VR能三维再现瘘管的形态和走行特点。结论MSCT平扫、增强并结合瘘管造影是一种有效而可靠的对肛瘘进行定位诊断的检查方法,可以为手术提供有效依据。
Objective To investigate the clinical value of multislice spiral CT (MSCT) in the diagnosis of anal fistula by plain scan, contrast enhancement and fistulography. Methods From July 2004 to May 2006, 32 cases of clinically suspected anal fistula were used in the first affiliated hospital of Wenzhou Medical College by 16-slice spiral CT scan and fistulectomy. The original images were reconstructed using Multi-Plane Reconstruction (MPR) and Volume Reconstruction (VR) techniques and the post-processing images were performed by radiologists. The preoperative imaging data were compared with microscopic anal fistula surgery and follow-up results. Results 4 cases of MSCT found no anal fistula, 5 cases of simple anal fistula, 23 cases of complex anal fistula were confirmed by surgery, anorectal specialist examination of 8 cases of complicated anal fistula misdiagnosed as simple anal fistula. MSCT low fistula in 6 cases, 22 cases of high fistula, were confirmed by surgery, including anorectal specialist examination of 8 cases of high fistula misdiagnosed as low anal fistula, MSCT on the 3 cases of sphincter fistula misdiagnosed as sphincteric fistula. The accuracy of MSCT in evaluating the preoperative mouth, branch and abscess was 62.1%, 89.3% and 100.0% respectively. MSCT postprocessing and reconstruction techniques, MPR including surface reconstruction (CPR) can clearly show the specific location of the fistula and its relationship with the internal and external anal sphincter and levator ani muscle, VR can reproduce the shape of three-dimensional fistula and walking characteristics. Conclusion MSCT scan, enhanced and combined with fistulography is an effective and reliable method for the diagnosis of anal fistula diagnosis, which can provide an effective basis for surgery.