Ding Yu-Wen, Yin Hao-Qiang, Liang Hong-Tao, Lu Jin-Gen, Wang Bo, Wang Chen
Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China.
Department of Ultrasonic, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China.
Gastroenterol Rep (Oxf). 2022 Nov 29;10:goac071. doi: 10.1093/gastro/goac071. eCollection 2022.
Pediatric perianal fistula is a common disorder. It is more difficult to detect the fistula tract and internal opening (IO) in children than in adults. This study aimed to evaluate the clinical diagnostic value of transcutaneous perianal ultrasound for children with perianal fistula.
A retrospective review was conducted by analysing the preoperative transcutaneous perianal ultrasound and intraoperative exploration results of 203 consecutive patients who were <3 years old and diagnosed with perianal fistula. Analyses were conducted to evaluate the accuracy and consistency of utilizing the transcutaneous perianal ultrasound in the diagnosis of the complexity and location of the IO of perianal fistulas.
Compared with intraoperative exploration, the preoperative transcutaneous perianal ultrasonography has almost perfect agreement (Kappa = 0.881, <0.001) in the diagnosis of fistula tract complexity and IO with a sensitivity of 92% and a specificity of 97%. In addition, both intraoperative exploration and transcutaneous perianal ultrasound diagnosis showed high consistency in the identification of the IO of perianal fistulas (Quadrant I Kappa = 0.831, Quadrant II Kappa = 0.773, Quadrant III Kappa = 0.735, Quadrant IV Kappa = 0.802, all <0.01). The IOs were mainly distributed in Quadrants IV and II in both simple and complex fistulas.
Transcutaneous perianal ultrasound, as a non-invasive and simple imaging technique, showed high accuracy in the diagnosis and identification of the fistula classification and IO location. It could be considered a first-line diagnostic instrument for evaluating perianal fistulas among children.
小儿肛周瘘是一种常见疾病。相较于成人，儿童的瘘管和内口更难检测。本研究旨在评估经皮肛周超声对小儿肛周瘘的临床诊断价值。
对203例年龄小于3岁且诊断为肛周瘘的连续患者的术前经皮肛周超声和术中探查结果进行回顾性分析。分析经皮肛周超声在诊断肛周瘘内口的复杂性和位置方面的准确性和一致性。
与术中探查相比，术前经皮肛周超声在诊断瘘管复杂性和内口方面具有几乎完美的一致性（Kappa = 0.881，P < 0.001），敏感性为92%，特异性为97%。此外，术中探查和经皮肛周超声诊断在肛周瘘内口的识别上均显示出高度一致性（I象限Kappa = 0.831，II象限Kappa = 0.773，III象限Kappa = 0.735，IV象限Kappa = 0.802，均P < 0.01）。简单瘘和复杂瘘的内口主要分布在IV象限和II象限。
经皮肛周超声作为一种无创且简单的成像技术，在诊断和识别瘘管分类及内口位置方面具有较高准确性。它可被视为评估小儿肛周瘘的一线诊断工具。
