Yang Jun, Li Qing, Li Hua, Zhang Heng, Ren Donglin, Zhang Zhiyi, Su Dan, Qian Haihua
Department of Anorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.
Department of Anorectal Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, P. R. China.
Gastroenterol Rep (Oxf). 2024 Feb 27;12:goae002. doi: 10.1093/gastro/goae002. eCollection 2024.
Accurate preoperative evaluation of fistula-in-ano can guide the choice of surgical procedure and may improve healing rates. This prospective study aimed to evaluate the accuracy of conventional 3D transperineal ultrasound (3D-TPUS) compared with SonoVue (SVE)-enhanced 3D-TPUS for the detection and classification of anal fistula.
In this prospective study, 3D-TPUS reconstructions were performed before and after SVE enhancement in 60 patients with fistula-in-ano who intended to undergo surgery at the Department of Anorectal Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University (P. R. China) between January 2021 and October 2021. Accuracies of anal fistula classification, complexity classification, detection of anal fistula branches, and detection of internal opening between 3D-TPUS and SVE 3D-TPUS were compared based on a reference standard-intraoperative findings.
This study enrolled 60 patients (mean age, 37.1 ± 11.4 years; mean follow-up, 9 ± 3 months). Intraoperative findings showed that the fistula type was intersphincteric in 23 patients (38.3%), trans-sphincteric in 35 (58.3%; 12 high and 23 low), and suprasphincteric in 2 (3.3%). Moreover, 68 internal openings were found. Compared with the accuracy of 3D-TPUS, that of SVE 3D-TPUS was similar in fistula classification [95.0% (57/60) vs 96.7% (58/60), =0.392], but significantly higher in internal opening evaluation [80.9% (55/68) vs 97.1% (66/68), =0.001], complexity classification [85.0% (51/60) vs 98.3% (59/60), =0.018], and detection of fistula branches [70.4% (19/27) vs 92.6% (25/27), =0.031].
SVE 3D-TPUS may be a useful examination for patients with perianal fistulae because of its high accuracy and consistency with intraoperative findings, especially in complex fistula-in-ano and difficult cases.
准确的肛管直肠瘘术前评估可指导手术方式的选择，并可能提高愈合率。本前瞻性研究旨在评估传统三维经会阴超声（3D-TPUS）与声诺维（SVE）增强三维经会阴超声在肛瘘检测和分类方面的准确性。
在这项前瞻性研究中，2021年1月至2021年10月期间，对山东大学齐鲁医院（中国山东省）肛肠外科拟行手术的60例肛管直肠瘘患者在SVE增强前后进行了3D-TPUS重建。基于术中发现这一参考标准，比较了3D-TPUS与SVE 3D-TPUS在肛瘘分类、复杂性分类、肛瘘分支检测及内口检测方面的准确性。
本研究纳入60例患者（平均年龄37.1±11.4岁；平均随访9±3个月）。术中发现瘘管类型为括约肌间型23例（38.3%），括约肌外型35例（58.3%；高位12例，低位23例），括约肌上型2例（3.3%）。此外，发现68个内口。与3D-TPUS的准确性相比，SVE 3D-TPUS在肛瘘分类方面相似[95.0%（57/60）对96.7%（58/60），P=0.392]，但在内口评估[80.9%（55/68）对97.1%（66/68），P=0.001]、复杂性分类[85.0%（51/60）对98.3%（59/60），P=0.018]及肛瘘分支检测[70.4%（19/27）对92.6%（25/27），P=0.031]方面显著更高。
SVE 3D-TPUS可能是肛周瘘患者的一种有用检查方法，因为其准确性高且与术中发现一致，尤其适用于复杂肛管直肠瘘及疑难病例。
