Effect of preoperative pelvic magnetic resonance imaging combined with intraoperative injection of hydrogen peroxide solution to locate the internal opening of anal fistula
-
摘要:目的
探讨术前盆腔核磁共振成像联合术中注射过氧化氢溶液定位肛瘘内口的准确性及其对肛瘘手术疗效影响。
方法选取南京医科大学附属逸夫医院肛肠外科86例肛瘘患者为研究对象，将其随机分为观察组(43例)和对照组(43例)。2组患者术前均行盆腔3.0T核磁共振成像检查，评估瘘管走形。对照组采用传统肛瘘探条结合术中肛门指检定位肛瘘内口，观察组术中采用经肛瘘外口缓慢注射过氧化氢溶液定位肛瘘内口。比较2组患者术中肛瘘内口定位准确情况、复杂肛瘘病例内口定位准确性情况。采用视觉模拟评分法(VAS)评分于术后1周评估患者创面疼痛情况，比较2组患者术后复发肛瘘例数、术后创面愈合时间和创面并发症的发生情况。
结果观察组患者肛瘘内口定位准确率高于对照组，差异有统计学意义(P < 0.05)。复杂肛瘘患者中，观察组准确定位内口10例，多于对照组的4例，差异有统计学意义(P < 0.05)。术后1周，观察组患者VAS评分为(1.53±0.91)分，低于对照组的(2.28±0.98)分，差异有统计学意义(P < 0.05)。观察组术后发生创面并发症3例，少于对照组的10例，差异有统计学意义(P < 0.05)。观察组创面愈合时间为(25.37± 3.86) d, 短于对照组的(29.05±2.62) d, 差异有统计学意义(P < 0.05)。
结论术前盆腔核磁共振成像检查联合术中注射过氧化氢溶液对肛瘘内口定位准确，能够减轻患者创面疼痛，降低术后并发症的发生率，有益于创面愈合。
Abstract:ObjectiveTo investigate the accuracy of preoperative pelvic magnetic resonance imaging combined with intraoperative injection of hydrogen peroxide solution to locate the internal orifice and its surgical efficacy for anal fistula.
MethodsA total of 86 patients with anal fistula admitted to Sir Run Run Hospital Affiliated to Nanjing Medical University were selected as study objects, and were randomly divided into observation group (43 cases) and control group(43 cases). All patients underwent pelvic 3.0T pelvic magnetic resonance imaging examination before operation. The fistula distribution was assessed. In the observation group, hydrogen peroxide solution was slowly injected through the external opening to locate the internal opening of anal fistula. The control group used traditional anal fistula probe combined with digital rectal examination to locate the internal opening of anal fistula. The accuracy of intraoperative positioning of the internal orifice of anal fistula in the two groups and the accuracy of the internal orifice positioning in complex anal fistula cases were compared. Visual Analog Scale (VAS) was used to evaluate the wound pain of patients 1 week after surgery, and the number of postoperative recurrent anal fistulas, postoperative wound healing time and the incidence of wound complications were compared between the two groups.
ResultsThe positioning accuracy rate of the anal internal opening in the observation group was higher than that in the control group, and the difference was statistically significant (P < 0.05). The number of complex anal fistula in patients in the observation group was more than that in the control group(10 cases versus 4 cases, P < 0.05). One week after surgery, VAS score of observation group was (1.53±0.91), which was lower than (2.28±0.98) in the control group, and the difference was statistically significant(P < 0.05). The wound healing time in the observation group was shorter than that in the control group [(25.37±3.86) d versus (29.05±2.62) d, P < 0.05].
ConclusionPreoperative pelvic magnetic resonance imaging combined with intraoperative injection of hydrogen peroxide solution is accurate in locating the internal orifice of anal fistula, can relieve the pain of patients′ wounds, and reduce the incidence of postoperative complications, therefore, it is beneficial to wound healing.
-
-
[1] CIROCCHI R, TRASTULLI S, MORELLI U, et al. The treatment of anal fistulas with biologically derived products: is innovation better than conventional surgical treatment An update[J]. Tech Coloproctol, 2013, 17(3): 259-273. doi: 10.1007/s10151-012-0948-9
[2] CHUNG W, KO D, SUN C, et al. Outcomes of anal fistula surgery in patients with inflammatory bowel disease[J]. Am J Surg, 2010, 199(5): 609-613. doi: 10.1016/j.amjsurg.2010.01.007
[3] RIZZO J A, NAIG A L, JOHNSON E K. Anorectal abscess and fistula-in-ano: evidence-based management[J]. Surg Clin North Am, 2010, 90(1): 45-68. doi: 10.1016/j.suc.2009.10.001
[4] BEETS-TAN R G, BEETS G L, VAN DER HOOP A G, et al. Preoperative MR imaging of anal fistulas: does it really help the surgeon[J]. Radiology, 2001, 218(1): 75-84. doi: 10.1148/radiology.218.1.r01dc0575
[5] 金佳熙, 李晓卿, 刘耀, 等. 3D CUBE T2WI抑脂序列联合常规序列对肛瘘的诊断价值[J]. 中国中西医结合影像学杂志, 2019, 17(2): 191-193. doi: 10.3969/j.issn.1672-0512.2019.02.024 [6] NAGENDRANATH C, SARAVANAN M N, SRIDHAR C, et al. Peroxide-enhanced endoanal ultrasound in preoperative assessment of complex fistula-in-ano[J]. Tech Coloproctol, 2014, 18(5): 433-438. doi: 10.1007/s10151-013-1067-y
[7] 中国医师协会肛肠医师分会临床指南工作委员会. 肛瘘诊治中国专家共识(2020版)[J]. 中华胃肠外科杂志, 2020, 23(12): 1123-1130. doi: 10.3760/cma.j.cn.441530-20200925-00537 [8] ROJANASAKUL A, PATTANAARUN J, SAHAKITRUNGRUANG C, et al. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract[J]. Chotmaihet Thangphaet, 2007, 90(3): 581-586.
[9] CIROCCO W C, REILLY J C. Challenging the predictive accuracy of Goodsall's rule for anal fistulas[J]. Dis Colon Rectum, 1992, 35(6): 537-542. doi: 10.1007/BF02050532
[10] KIM Y, PARK Y J. Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H2O2 enhancement[J]. World J Gastroenterol, 2009, 15(38): 4810. doi: 10.3748/wjg.15.4810
[11] CHOEN S, BURNETT S, BARTRAM C I, et al. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae[J]. Br J Surg, 1991, 78(4): 445-447.
[12] KHATI N J, SONDEL LEWIS N, FRAZIER A A, et al. CT of acute perianal abscesses and infected fistulae: a pictorial essay[J]. Emerg Radiol, 2015, 22(3): 329-335. doi: 10.1007/s10140-014-1284-3
[13] BALC X S, ONUR M R, KARAOSMANO X F, et al. MRI evaluation of anal and perianal diseases[J]. Diagn Interv Radiol, 2019, 25(1): 21-27. doi: 10.5152/dir.2018.17499
[14] SAHNI V A, AHMAD R, BURLING D. Which method is best for imaging of perianal fistula[J]. Abdom Imaging, 2008, 33(1): 26-30. doi: 10.1007/s00261-007-9309-y
[15] TOZER P J, BURLING D, GUPTA A, et al. Review article: medical, surgical and radiological management of perianal Crohn's fistulas[J]. Aliment Pharmacol Ther, 2011, 33(1): 5-22. doi: 10.1111/j.1365-2036.2010.04486.x
[16] 王宇. 3.0 T磁共振多序列成像在肛瘘诊断分型中的应用效果分析[J]. 中国实用医药, 2022, 17(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202201001.htm [17] URIBE N, BALCISCUETA Z, MÍNGUEZ M, et al. "Core out" or "curettage" in rectal advancement flap for cryptoglandular anal fistula[J]. Int J Colorectal Dis, 2015, 30(5): 613-619. doi: 10.1007/s00384-015-2133-x
计量
- 文章访问数: 143
- HTML全文浏览量: 130
- PDF下载量: 9
下载:
苏公网安备 32100302010246号
