Department of Surgery and Transplantation, Tel Hashomer Hospital, Ramat Aviv, Israel.
Colorectal Dis. 2013 Aug;15(8):1011-8. doi: 10.1111/codi.12204.
Successful anal fistula care is aided by specialized imaging accurately defining the site of the internal opening and fistula type. Imaging techniques are complementary, designed to answer specific anatomical questions. There are limited data concerning the clinical value of transperineal ultrasound (TP-US) in both cryptogenic fistula-in-ano and perianal Crohn's disease (PACD). The aim of the study was to assess the accuracy of TP-US compared with operative findings in patients with perirectal sepsis.
Patients with recurrent cryptogenic anal fistula and PACD referred for sonography were examined using TP-US by a single examiner blinded to the operative results. Fistulae were categorized by the Parks classification predicting the site of the internal fistula opening. Ancillary horseshoe collections, abscesses and secondary tracks were defined.
Fourteen patients with PACD and 27 patients with recurrent cryptogenic fistula-in-ano were analysed with comparative images and operative data. Correlation of fistula type for cryptogenic and PACD patients respectively was 23/27 (85.2%) and 12/14 (85.7%), with a correlative internal opening site (when found at surgery) of 16/22 (72.3%) and 12/14 (85.7%). Misclassification of fistula type in cryptogenic cases occurred in the presence of ancillary abscesses with associated acoustic shadowing. In PACD patients, TP-US was used when anal stenosis precluded endoanal ultrasonography, assisting in the diagnosis of recto-vaginal fistulae.
TP-US is a useful complementary technique to assess fistula-in-ano and has special advantage when there is anal canal distortion, complex fistula type or suspicion of a recto-vaginal fistula.
专门的影像学技术通过准确地确定内口的位置和瘘管类型，有助于实现肛瘘的成功治疗。影像学技术具有互补性，旨在回答特定的解剖问题。关于经会阴超声（TP-US）在隐匿性肛旁脓肿和肛周克罗恩病（PACD）中的临床价值，数据有限。本研究旨在评估与手术结果相比，TP-US 在肛周脓肿患者中的准确性。
对因超声检查而转诊的复发性隐匿性肛瘘和 PACD 患者进行 TP-US 检查，由一位对手术结果不知情的单一检查者进行检查。瘘管按 Parks 分类进行分类，预测内口的位置。辅助马蹄形集合、脓肿和二级轨迹被定义。
对 14 例 PACD 患者和 27 例复发性隐匿性肛瘘患者进行了比较图像和手术数据分析。隐匿性和 PACD 患者的瘘管类型相关性分别为 23/27（85.2%）和 12/14（85.7%），当在手术中发现时，相关性内口位置分别为 16/22（72.3%）和 12/14（85.7%）。隐匿性病例中瘘管类型的分类错误发生在伴有相关声影的辅助脓肿存在的情况下。在 PACD 患者中，当肛门狭窄妨碍经肛门超声检查时，使用 TP-US 辅助诊断直肠阴道瘘。
TP-US 是一种评估肛瘘的有用的补充技术，当存在肛管扭曲、复杂的瘘管类型或怀疑直肠阴道瘘时，具有特殊优势。
