Aslam A, Grier D J, Duncan A W, Spicer R D
Department of Paediatric Surgery, Bristol Royal Hospital for Sick Children, Bristol BS2 8BJ, United Kingdom.
Pediatr Surg Int. 1998 Nov;14(1-2):71-3. doi: 10.1007/s003830050439.
The role of magnetic resonance imaging (MRI) compared to other investigations in providing information relevant to and affecting surgical management in patients with anorectal anomalies (ARA) was studied in two groups of patients. In group 1 a pilot study was done in 9 patients with colostomy for high ARA awaiting posterior sagittal anorectoplasty. These patients had MRI, plain radiographs, a distal loopogram through the mucous fistula, ultrasound scans of the spinal cord and urinary tract, and a micturating cystourethrogram. The level of bowel and spinal-cord termination was correctly determined in all patients by MRI and conventional investigations. The presence or absence of a fistula, urological abnormalities, and bony abnormalities of the pelvis and spine were better visualized by conventional investigations than with MRI. The striated-muscle complex (SMC) was well-visualized by MRI, the thickness accurately graded, and the findings confirmed at operation. The information on muscle thickness and the presence or absence of a fistula was interesting, but played no part in decisions made about surgical management, and the operative technique was not altered. In group 2 the patients were much older and had MRI for persistent problems, mainly soiling; 6 had low lesions and 6 had high lesions. Three patients with low lesions were found to have intraspinal abnormalities on MRI; 4 were found to have malpositioned bowel in the SMC, which was again accurately visualized and graded. Therefore, in 7/12 patients of this group a surgically correctable abnormality was found. We conclude that MRI has no role as a primary investigation in patients with high ARA, but it is useful if there are suspected spinal-cord problems or persistent problems after definitive surgery.
在两组患者中研究了磁共振成像（MRI）与其他检查相比，在提供与肛门直肠畸形（ARA）患者手术管理相关且影响手术管理的信息方面所起的作用。在第1组中，对9例因高位ARA行结肠造口术并等待后矢状位肛门直肠成形术的患者进行了一项初步研究。这些患者接受了MRI、平片、经黏液瘘的远端肠袢造影、脊髓和尿路超声扫描以及排尿性膀胱尿道造影。通过MRI和传统检查在所有患者中均正确确定了肠管和脊髓终止的水平。传统检查比MRI能更好地显示是否存在瘘管、泌尿系统异常以及骨盆和脊柱的骨质异常。MRI能很好地显示横纹肌复合体（SMC），准确分级其厚度，且手术结果证实了这些发现。关于肌肉厚度以及是否存在瘘管的信息很有意思，但在手术管理决策中未起作用，手术技术也未改变。在第2组中，患者年龄大得多，因持续存在问题（主要是大便失禁）而接受MRI检查；6例为低位病变，6例为高位病变。3例低位病变患者经MRI检查发现有脊髓内异常；4例发现肠管在SMC中位置异常，同样能准确显示并分级。因此，在该组12例患者中有7例发现了可通过手术纠正的异常。我们得出结论，MRI在高位ARA患者中不作为主要检查手段，但如果怀疑有脊髓问题或在确定性手术后存在持续问题则很有用。
