Maconi Giovanni, Ardizzone Sandro, Greco Salvatore, Radice Elisa, Bezzio Cristina, Bianchi Porro Gabriele
Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, University of Milan, Italy.
Am J Gastroenterol. 2007 Oct;102(10):2214-9. doi: 10.1111/j.1572-0241.2007.01441.x. Epub 2006 Aug 4.
Perianal and rectovaginal fistulae are common complications in Crohn's disease. Magnetic resonance imaging (MRI) and endoanal ultrasound are used for imaging perianal fistulae and abscesses, but both methods require expensive equipment and experienced investigators. Transperineal ultrasound may represent another method of detecting perianal complications in Crohn's disease. We investigated Crohn's disease perianal and rectovaginal fistulae using transperineal ultrasound and compared the findings with results of endoanal ultrasound as reference standard.
A total of 46 patients with Crohn's disease and perianal and/or rectovaginal or anovulvar fistulae underwent, transperineal and endoanal ultrasound, on the same day. Transperineal ultrasound was performed using regular convex and high-resolution linear probes. Endoanal ultrasound was performed using an ultrasound system with a 7 MHz rotating endoanal probe. Fistulae were classified according to Parks' classification in intrasphincteric, transsphincteric, suprasphincteric, and extrasphincteric. Rectovaginal or anovulvar fistulae were described separately. Presence of abscesses was also reported.
Fifty-two fistulae (3 intra-sphincteric, 28 transsphincteric, 8 suprasphincteric, 2 extrasphincteric, 9 rectovaginal, and 2 anovulvar) were detected by transperineal ultrasound. Endoanal ultrasound confirmed the correct classification of 45 fistulae (predictive positive value: 86.5%). Of the 53 fistulae detected by endoanal ultrasound, 45 were correctly classified by transperineal ultrasound (sensitivity 84.9%). Transperineal ultrasound showed 10 perianal abscesses: 2 horseshoe, 4 deep, and 4 superficial. Endoanal ultrasound confirmed all horseshoe, 3 deep, and 2 superficial abscesses and did not find further abscesses.
Transperineal ultrasound is a simple, painless, real-time method to detect and classify perianal and rectovaginal fistulae and/or abscesses in Crohn's disease.
肛周和直肠阴道瘘是克罗恩病的常见并发症。磁共振成像（MRI）和肛门内超声用于肛周瘘管和脓肿的成像，但这两种方法都需要昂贵的设备和经验丰富的研究人员。经会阴超声可能是检测克罗恩病肛周并发症的另一种方法。我们使用经会阴超声对克罗恩病的肛周和直肠阴道瘘进行了研究，并将结果与作为参考标准的肛门内超声结果进行了比较。
共有46例患有克罗恩病且伴有肛周和/或直肠阴道或肛门外阴瘘的患者在同一天接受了经会阴超声和肛门内超声检查。经会阴超声使用常规凸阵探头和高分辨率线性探头进行。肛门内超声使用带有7MHz旋转肛门内探头的超声系统进行。瘘管根据帕克斯分类法分为括约肌内型、括约肌间型、括约肌上型和括约肌外型。直肠阴道或肛门外阴瘘分别进行描述。同时报告脓肿的存在情况。
经会阴超声检测到52个瘘管（3个括约肌内型、28个括约肌间型、8个括约肌上型、2个括约肌外型、9个直肠阴道型和2个肛门外阴型）。肛门内超声确认了45个瘘管的正确分类（预测阳性值：86.5%）。在肛门内超声检测到的53个瘘管中，45个经会阴超声正确分类（敏感性84.9%）。经会阴超声显示10个肛周脓肿：2个马蹄形、4个深部和4个浅部。肛门内超声确认了所有马蹄形脓肿、3个深部脓肿和2个浅部脓肿，未发现其他脓肿。
经会阴超声是一种简单、无痛、实时的方法，可用于检测和分类克罗恩病的肛周和直肠阴道瘘及/或脓肿。
