磁共振成像对复发性肛瘘临床结局的影响。

Effect of MRI on clinical outcome of recurrent fistula-in-ano.

作者信息

Buchanan Gordon, Halligan Steve, Williams Andrew, Cohen C Richard G, Tarroni Danilo, Phillips Robin K S, Bartram Clive I

机构信息

Department of Surgery, St Mark's Hospital, Northwick Park, HA1 3UJ, London, .

出版信息

Lancet. 2002 Nov 23;360(9346):1661-2. doi: 10.1016/S0140-6736(02)11605-9.

DOI:10.1016/S0140-6736(02)11605-9

PMID:12457791

Abstract

Recurrent fistula-in-ano is usually due to sepsis missed at surgery, which can be identified by MRI. We aimed to establish the therapeutic effect of MRI in patients with fistula-in-ano. We did MRI in 71 patients with recurrent fistula, with further surgery done at the discretion of the surgeon. Surgery and MRI agreed in 40 patients, five (13%) of whom had further recurrence, compared with 16 (52%) of 31 in whom surgery and MRI disagreed (p=0.0005). Further recurrence in all 16 was at the site predicted by MRI. For surgeons who always acted on MRI, further recurrences arose in four of 25 (16%) operations versus eight of 14 (57%) operations for those who ignored imaging (p=0.008). Surgery guided by MRI reduces further recurrence of fistula-in-ano by 75% and should be done in all patients with recurrent fistula.

摘要

复发性肛瘘通常是由于手术时遗漏了脓毒症，这可通过磁共振成像（MRI）识别。我们旨在确定MRI对肛瘘患者的治疗效果。我们对71例复发性肛瘘患者进行了MRI检查，并由外科医生酌情进行进一步手术。40例患者的手术结果与MRI结果相符，其中5例（13%）出现进一步复发，而在31例手术结果与MRI结果不符的患者中，有16例（52%）出现进一步复发（p=0.0005）。所有16例进一步复发均发生在MRI预测的部位。对于始终根据MRI结果进行手术的外科医生，25例手术中有4例（16%）出现进一步复发，而对于忽视影像学检查结果的外科医生，14例手术中有8例（57%）出现进一步复发（p=0.008）。由MRI引导的手术可使复发性肛瘘的进一步复发率降低75%，所有复发性肛瘘患者均应接受该手术。