CAJ | 학술논문

目的：探讨三维肛管直肠腔内超声（3D-EAUS）检查在肛瘘术前评估中的应用价值。方法前瞻性纳入2012年3月至2013年3月第二炮兵总医院结直肠肛门外科连续收治的诊断明确、拟行手术的100例肛瘘患者，采用计算机产生随机号的方法随机分为超声组和对照组，每组各50例。超声组术前采用3D-EAUS检查，对照组术前常规检查、采用指诊或探针探查，比较两组肛瘘内口定位、肛瘘分型及是否存在分支瘘管的准确率。结果与对照组比较，超声组的内口定位准确率较高，超声组和对照组分别为96．0％（48／50）和82．0％（41／50）（P＝0．02）。超声组与对照组对复杂性肛瘘的诊断分别为96．7％（29／30）比74．1％（20／27）（P＝0．021）；对肛瘘分型的诊断分别为96．0％（48／50）比78％（39／50）（P＝0．01）；对是否存在分支瘘管的诊断分别为94．0％（47／50）比84．0％（42／50）（P＝0．025）。但对于简单性肛瘘，两组内口定位准确率相当[95．0％（19／20）比91．3％（21／23）， P＝1．000]。结论三维肛管直肠腔内超声在内口定位、瘘管分型及分支瘘管的诊断方面具有较高的应用价值，尤其对复杂性肛瘘患者，值得在临床推广。
목적：탐토삼유항관직장강내초성（3D-EAUS）검사재항루술전평고중적응용개치。방법전첨성납입2012년3월지2013년3월제이포병총의원결직장항문외과련속수치적진단명학、의행수술적100례항루환자，채용계산궤산생수궤호적방법수궤분위초성조화대조조，매조각50례。초성조술전채용3D-EAUS검사，대조조술전상규검사、채용지진혹탐침탐사，비교량조항루내구정위、항루분형급시부존재분지루관적준학솔。결과여대조조비교，초성조적내구정위준학솔교고，초성조화대조조분별위96．0％（48／50）화82．0％（41／50）（P＝0．02）。초성조여대조조대복잡성항루적진단분별위96．7％（29／30）비74．1％（20／27）（P＝0．021）；대항루분형적진단분별위96．0％（48／50）비78％（39／50）（P＝0．01）；대시부존재분지루관적진단분별위94．0％（47／50）비84．0％（42／50）（P＝0．025）。단대우간단성항루，량조내구정위준학솔상당[95．0％（19／20）비91．3％（21／23）， P＝1．000]。결론삼유항관직장강내초성재내구정위、루관분형급분지루관적진단방면구유교고적응용개치，우기대복잡성항루환자，치득재림상추엄。
Objective To explore the value of preoperative evaluation with three-dimensional endoanal ultrasonography (3D-EAUS) for anal fistula in order to provide preoperative assessment for anal fistula. Methods One hundred patients diagnosed with anal fistula undergoing surgery between March 2012 and March 2013 in our department were prospectively enrolled. All the patients were randomly divided into the ultrasound group and the control group with fifty patients in each group. The ultrasound group received 3D-EAUS and the control group received routine examinations (digital examination and probe) to assess the position of the internal opening, the type of fistula and secondary tracks, respectively. The concordance rate of the preoperative assessment and intraoperative exploration was evaluated between the two groups. Results The accuracy of identifying internal opening was 96.0%for the ultrasound group and 82.0% for the control group with statistically significant difference (P=0.02). The accuracy of identifying internal opening for simple anal fistula was similar (95.0% vs. 91.3%, P=1). For complex anal fistula, the accuracy was also higher in the ultrasound group (96.7%vs. 74.1%, P=0.025). The accuracy of fistula classification was 78.0% for the ultrasound group and 96.0% for the control group with significant difference (P=0.01). The accuracy of identifying a second track was higher in the ultrasound group (96.0% vs. 82.0%, P=0.025). Conclusions It is significantly superior for 3D-EAUS to detect the internal opening , fistula classification and identification of a second track in complex anal fistulas as compared to conventional examination. 3D-EAUS should be recommended as a preoperative assessment for anal fistula , especially for complex one.