本文選題：肛瘺 + 經(jīng)直腸雙平面超聲��； 參考：《安徽中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的采用經(jīng)直腸雙平面超聲、經(jīng)會(huì)陰部高頻超聲及二者聯(lián)合超聲檢查技術(shù)研究肛瘺超聲影像特征,并以手術(shù)醫(yī)師術(shù)中診斷為金標(biāo)準(zhǔn),分析各種檢查方法在肛瘺診斷中的診斷效果及應(yīng)用價(jià)值。方法回顧性分析我院71例分別采用經(jīng)會(huì)陰部高頻超聲、經(jīng)直腸雙平面超聲及二者聯(lián)合超聲檢查方式探查肛瘺的超聲影像特征,并與手術(shù)醫(yī)師術(shù)中診斷對(duì)照,計(jì)算不同超聲診斷方式診斷肛瘺內(nèi)口位置、外口位置、主瘺管數(shù)、分支瘺管數(shù)及肛瘺的分型與手術(shù)結(jié)果的符合率,分析經(jīng)直腸雙平面超聲、經(jīng)會(huì)陰部高頻超聲及二者聯(lián)合診斷優(yōu)勢(shì)及缺點(diǎn),總結(jié)出診斷肛瘺更有效的超聲檢查方法。結(jié)果(1)經(jīng)會(huì)陰部高頻超聲檢出主瘺管數(shù)、分支瘺管數(shù)、內(nèi)口、外口數(shù)為92、41、35、111,經(jīng)直腸雙平面超聲檢出主瘺管、分支瘺管、內(nèi)口、外口數(shù)分別為94、43、100、2,二者聯(lián)合探查檢出主瘺管、分支瘺管、內(nèi)口、外口數(shù)分別為112、51、110、119,手術(shù)中結(jié)果證實(shí)的主瘺管數(shù)、分支瘺管數(shù)、內(nèi)口、外口數(shù)為117、53、114、120。(2)對(duì)于主瘺管探查,三種不同方法對(duì)主瘺管檢出率的差異總體上具有統(tǒng)計(jì)學(xué)意義(χ~2=16.179、P0.001)。兩兩比較結(jié)果顯示,二者聯(lián)合超聲的檢出率(95.73%)大于經(jīng)會(huì)陰高頻超聲和經(jīng)直腸雙平面超聲的檢出率(兩者分別為78.63%和80.34%),且差異具有統(tǒng)計(jì)學(xué)意義;而經(jīng)會(huì)陰高頻超聲和經(jīng)直腸雙平面超聲的檢出率沒有統(tǒng)計(jì)學(xué)差異。(3)對(duì)于分支瘺管檢查,三種不同方法對(duì)分支瘺管檢出率的差異總體上具有統(tǒng)計(jì)學(xué)意義(χ~2=8.244、P=0.0160.05)。兩兩比較結(jié)果顯示,二者聯(lián)合超聲的檢出率(96.23%)大于經(jīng)會(huì)陰高頻超聲和經(jīng)直腸雙平面超聲的檢出率(兩者分別為77.36%和81.13%),且差異具有統(tǒng)計(jì)學(xué)意義;而經(jīng)會(huì)陰高頻超聲和經(jīng)直腸雙平面超聲的檢出率沒有統(tǒng)計(jì)學(xué)差異。(4)對(duì)于內(nèi)口探查,三種不同方法對(duì)內(nèi)口檢出率的差異總體上具有統(tǒng)計(jì)學(xué)意義(χ~2=143.190、P0.001)。兩兩比較結(jié)果顯示,二者聯(lián)合超聲的檢出率(96.49%)大于經(jīng)會(huì)陰高頻超聲和經(jīng)直腸雙平面超聲的檢出率(兩者分別為30.70%和87.72%),且差異具有統(tǒng)計(jì)學(xué)意義;而經(jīng)直腸雙平面超聲的檢出率(87.72%)大于經(jīng)會(huì)陰高頻超聲的檢出率(30.70%),且差異具有統(tǒng)計(jì)學(xué)意義。(5)對(duì)于外口探查,三種不同方法對(duì)外口檢出率的差異總體上具有統(tǒng)計(jì)學(xué)意義(χ~2=310.757、P0.001)。兩兩比較結(jié)果顯示,二者聯(lián)合超聲的檢出率(99.17%)大于經(jīng)會(huì)陰高頻超聲和經(jīng)直腸雙平面超聲的檢出率(兩者分別為92.50%和1.67%),且差異具有統(tǒng)計(jì)學(xué)意義;而經(jīng)會(huì)陰高頻超聲的檢出率(92.50%)大于經(jīng)直腸雙平面超聲的檢出率(1.67%),且差異具有統(tǒng)計(jì)學(xué)意義。(6)根據(jù)肛瘺主瘺管與肛管括約肌關(guān)系判斷Parks分型,(1)二者聯(lián)合診斷方式超聲檢查括約肌間型、經(jīng)括約肌型的準(zhǔn)確率明顯要比于對(duì)括約肌上型和括約肌外型肛瘺的準(zhǔn)確率高。(2)二者聯(lián)合超聲診斷方式對(duì)括約肌間型和經(jīng)括約肌型的檢出率均為100%,且兩組差異無統(tǒng)計(jì)學(xué)意義;二者聯(lián)合超聲診斷方式對(duì)這兩種分型肛瘺具有極高的診斷準(zhǔn)確率,漏診率幾乎為0%。(3)二者聯(lián)合超聲診斷方式對(duì)括約肌上型和括約肌外型的檢出率分別為40%和0%,且兩組差異無統(tǒng)計(jì)學(xué)意義;二者聯(lián)合超聲對(duì)這兩種分型肛瘺診斷準(zhǔn)確率均較低,漏診率較高。結(jié)論經(jīng)會(huì)陰部高頻超聲對(duì)肛瘺外口及肛瘺管肛周皮下段顯示清晰,經(jīng)直腸雙平面超聲對(duì)肛瘺內(nèi)口、瘺管與括約肌關(guān)系及瘺管的肛管較深部段顯示清晰,因此兩種方法聯(lián)合探查對(duì)于肛瘺的診斷具有更高的臨床價(jià)值。
[Abstract]:Objective to study the ultrasonographic features of anal fistula by transrectal double plane ultrasound, transperineal high-frequency ultrasound and two cases combined ultrasonic examination, and to analyze the diagnostic effect and application value of various methods in the diagnosis of anal fistula with the diagnostic gold standard of the surgeons. Methods 71 cases in our hospital were analyzed retrospectively. High frequency ultrasound, transrectal double plane ultrasound and two combined ultrasonic examination were used to investigate the ultrasonographic features of anal fistula, and compared with the surgeons, and compared with the surgeons, to calculate the location of the anal fistula, the position of the external mouth, the number of main fistula, the number of fistula and the coincidence of the anus fistula and the operation results. Biplane ultrasound, with the combined diagnosis of the perineal high-frequency ultrasound and the combined diagnosis of two cases, summed up a more effective diagnostic method for the diagnosis of anal fistula. Results (1) the number of the main fistula, the number of branch fistula, the internal mouth, the number of external mouth were 92,41,35111, and the number of fistula, branch fistula, internal mouth, and the number of external mouth were detected by the transrectal high frequency ultrasound. The number of main fistula, branch fistula, internal mouth and external mouth were 112,51110119 respectively. The number of main fistula, branch fistula, internal mouth and external mouth were 117,53114120. (2) for main fistula, the difference in the detection rate of main fistula in three different methods was statistically significant (94,43100,2). X ~2=16.179, P0.001). 22 comparison results showed that the detection rate of combined ultrasound (95.73%) was greater than that of transperineal high frequency ultrasound and transrectal biplane ultrasound (78.63% and 80.34% respectively), and the difference was statistically significant, but there was no statistical difference between perineal high frequency ultrasound and transrectal biplane ultrasound. 3) for branch fistula examination, the difference in the detection rate of branch fistula in three different methods was statistically significant (x ~2=8.244, P=0.0160.05). 22 comparison results showed that the detection rate of combined ultrasound (96.23%) in two cases was greater than that of transperineal high frequency ultrasound and transrectal biplane ultrasound (77.36% and 81.13% respectively). The difference was statistically significant, but the detection rate of the transperineal high frequency ultrasound and the transrectal biplane ultrasound was not statistically significant. (4) for the internal oral exploration, the difference in the detection rate of the inner mouth of the three different methods was statistically significant (x ~2=143.190, P0.001). The 22 ratio showed that the detection rate of the two combined ultrasound (96.49%) was significant. The detection rates of transperineal high frequency ultrasound and transrectal biplane ultrasound (both 30.70% and 87.72%) were statistically significant, while the detection rate of transrectal biplane ultrasound (87.72%) was greater than that of perineum high frequency ultrasound (30.70%), and the difference was statistically significant. (5) for external exploration, three different methods were applied to the outside world. The difference in oral detection rate was statistically significant (x ~2=310.757, P0.001). 22 The results showed that the detection rate of the two combined ultrasound (99.17%) was greater than that of the transperineal high frequency ultrasound and the transrectal biplane ultrasound (92.50% and 1.67% respectively), and the difference was statistically significant; and the detection of the perineum high frequency ultrasound was a significant difference. The rate (92.50%) was greater than that of the transrectal biplane ultrasound (1.67%), and the difference was statistically significant. (6) according to the relationship between the anal fistula and the anal sphincter, the Parks classification was judged, and (1) two combined diagnostic methods were used to examine the INTERSPHINCTER type. The accuracy of the sphincter type was significantly higher than that of the sphincter type and the sphincter anal fistula. The rate of accuracy was high. (2) the detection rate of INTERSPHINCTER type and sphincter type was 100% with two combined ultrasonic diagnostic methods, and there was no significant difference between the two groups. The two combined ultrasonic diagnosis method had high diagnostic accuracy for the two types of anal fistula, and the missed diagnosis rate was almost 0%. (3) two combined ultrasound diagnosis on the upper sphincter type. The detection rates of the external sphincter and the sphincter were 40% and 0% respectively, and there was no significant difference in the two groups. The diagnostic accuracy of the two types of anal fistula was lower and the rate of missed diagnosis was higher in two cases. The relationship between sphincter and the depth of the anal canal is clear. Therefore, the combination of the two methods has a higher clinical value for the diagnosis of anal fistula.

【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R657.16

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