Zbar A P, Armitage N C
University of the West Indies School of Clinical and Medicine Research, Queen Elizabeth Hospital, St. Michael, Barbados.
Tech Coloproctol. 2006 Jul;10(2):83-93. doi: 10.1007/s10151-006-0258-1. Epub 2006 Jun 19.
The use of specialized imaging to assess cryptogenic fistula-in-ano is selective, aimed at delineation of the site of the internal fistula opening and the relationship of the primary and secondary tracks and collections to the main levator plate. Advanced imaging also permits definition of the destructive effects of perirectal sepsis (e.g. internal or external anal sphincter damage, perineal body destruction and an ano- or rectovaginal fistula), which may require secondary reconstructive surgery.
We performed a PubMed search of outcomes for fistula management in the English and non-English literature, and summarized results regarding the accuracy of internal opening and horseshoe detection as well as the operative correlation for cryptogenic and non-cryptogenic fistula-in-ano using endoanal ultrasound (EAUS) and magnetic resonance (MR) imaging. Only literature defining these characteristics was included.
The advantages and limitations of the main forms of imaging are discussed in this review with emphasis on EAUS and endoanal or pelvic phased-array MR fistulography. The new technique of transperineal sonography is highlighted. A small but important group of patients with complex fistula-in-ano require specialized imaging. There are specific limitations of endoanal ultrasound (EAUS) which necessitate pelvic phased-array MR imaging. Initial work suggests that EAUS may have a role in intraoperative use for image-guided drainage of recurrent abscesses where operative interpretation can be difficult. The coloproctologist in a tertiary referral center must acquire the skills of ultrasound performance in order to successfully treat fistulous disease, suggesting a role for formal imaging accreditation as part of coloproctological training.
Future studies should determine both what sequential imaging algorithms for imaging are cost-effective as well as predictive of fistula cure.
使用专业成像技术评估隐源性肛瘘是有选择性的，目的是确定内瘘口的位置以及原发和继发瘘管及脓肿与主要肛提肌板的关系。先进的成像技术还可以明确直肠周围感染的破坏作用（如肛门内、外括约肌损伤、会阴体破坏以及肛门直肠瘘或直肠阴道瘘），这可能需要二期重建手术。
我们在PubMed上搜索了英文和非英文文献中肛瘘治疗的结果，并总结了关于使用腔内超声（EAUS）和磁共振（MR）成像检测内口和马蹄形肛瘘的准确性以及隐源性和非隐源性肛瘘手术相关性的结果。仅纳入定义了这些特征的文献。
本综述讨论了主要成像方式的优缺点，重点是EAUS以及腔内或盆腔相控阵MR瘘管造影。突出了经会阴超声检查的新技术。一小部分但很重要的复杂肛瘘患者需要专业成像。腔内超声（EAUS）存在特定局限性，这就需要盆腔相控阵MR成像。初步研究表明，EAUS可能在术中用于复发性脓肿的图像引导引流，因为手术中难以进行判断。三级转诊中心的结直肠外科医生必须掌握超声操作技能，以便成功治疗肛瘘疾病，这表明正式的成像认证可作为结直肠外科培训的一部分。
未来的研究应确定哪些序贯成像算法既具有成本效益又能预测肛瘘治愈情况。
