Department of Ultrasound, Clinical Medical College, Chengdu, China; First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
First Affiliated Hospital of Chengdu Medical College, Chengdu, China; Traditional Chinese and Western Medicine Anorectal, Clinical Medical College, Chengdu, China.
Ultrasound Med Biol. 2022 Oct;48(10):2154-2161. doi: 10.1016/j.ultrasmedbio.2022.06.013. Epub 2022 Aug 7.
This study compared the diagnostic accuracy of percutaneous fistula contrast-enhanced ultrasound (CEUS) combined with 360° 3-D transrectal ultrasound (TRUS) imaging (CEUS + 360°-TRUS) with that of conventional transrectal ultrasound in the diagnosis of complex anal fistulas. A total of 156 patients clinically diagnosed with complex anal fistula from January 2020 to December 2021 were studied and randomly divided into an experimental group (n = 82) and a control group (n = 74). Patients in the experimental group were examined by percutaneous fistula CEUS combined with CEUS + 360°-TRUS, while patients in the control group were examined using TRUS. The detection of fistulas (main tract, branch and internal orifice) and the accuracy of Parks classification were compared between the two groups. Recurrences were followed up at 1, 3 and 6 mo after the surgery. A total of 156 patients were included, aged 23-68 y (average: 37.7 ± 18.2 y). In both groups, the course of disease was <1 mo in 128 cases, 1-2 mo in 22 cases and >3 mo in 6 cases. A total of 474 fistulas were confirmed by surgery in the aforementioned patients, including 224 main fistulas, 250 branch pipes and 254 internal orifices. The CEUS + 360°-TRUS group had 96.87%, 90.41% and 90.14% diagnostic accuracy for the main tract, branch and internal orifice, which was statistically significant (p < 0.001) compared with the 85.00%, 70.00% and 72.46% for the TRUS group, respectively. The overall accuracy of Parks classification of anal fistula in the CEUS + 360°-TRUS group was significantly higher than that in the TRUS group (90.24% vs. 78.38%, p < 0.001). After 6 mo of follow-up, the recurrence rate in the CEUS + 360°-TRUS group was 4.87%, and the recurrence rate in the TRUS group was 18.91%. Percutaneous fistula CEUS combined with transrectal 360° 3-D imaging has significantly higher accuracy than conventional TRUS in the diagnosis of complex anal fistula, especially for anal fistula branches, internal openings and Parks classification and is beneficial in reducing post-operative occurrence of complex anal fistulas.
本研究比较了经皮瘘管对比增强超声（CEUS）联合 360°三维经直肠超声（TRUS）成像（CEUS+360°-TRUS）与常规经直肠超声对复杂肛瘘的诊断准确性。2020 年 1 月至 2021 年 12 月，共对 156 例临床诊断为复杂肛瘘的患者进行了研究，并随机分为实验组（n=82）和对照组（n=74）。实验组患者接受经皮瘘管 CEUS 联合 CEUS+360°-TRUS 检查，对照组患者接受 TRUS 检查。比较两组患者对肛瘘（主瘘管、分支和内口）的检出情况和 Parks 分类的准确性。术后 1、3 和 6 个月进行随访。共纳入 156 例患者，年龄 23-68 岁（平均 37.7±18.2 岁）。两组中，病程 <1 个月者 128 例，1-2 个月者 22 例，>3 个月者 6 例。上述患者共手术证实瘘管 474 条，其中主瘘管 224 条，分支管道 250 条，内口 254 个。CEUS+360°-TRUS 组对主瘘管、分支和内口的诊断准确率分别为 96.87%、90.41%和 90.14%，显著高于 TRUS 组的 85.00%、70.00%和 72.46%（p < 0.001）。CEUS+360°-TRUS 组肛瘘 Parks 分类的总体准确率显著高于 TRUS 组（90.24% vs. 78.38%，p < 0.001）。随访 6 个月后，CEUS+360°-TRUS 组的复发率为 4.87%，TRUS 组的复发率为 18.91%。经皮瘘管 CEUS 联合直肠 360°三维成像在诊断复杂肛瘘方面的准确性明显高于常规 TRUS，特别是对肛瘘分支、内口和 Parks 分类，有利于减少复杂肛瘘术后的复发。
