The Study Of The Diagnosis Value Of 360° Transrectal Ultrasonography Combined With High-frequency Ultrasonography In Anal Fistula

Objective:To evaluate the diagnosis value of 360° transrectal ultrasonography(360°-TRUS)combined with high-frequency ultrasonography in anal fistula.Methold: 360°-TRUS combined with high-frequency ultrasonography was used to diagnose patients diagnosed with anal fistula clinically bettween April 2017 and December 2017,32 of whom with complete ultrasonography,enhanced Magnetic Resonance Imaging(MRI)examination and surgical records were accepted into the study group.First,high frequency probe was used to scancrissum sequentially to know location and shape of external opening,the presence of perianal abscess and judge fistula trace preliminarily.Then,intracavitary probe of 360°-TRUS was used to show anal and adjacent structures.Location and number of internal openings,trace and nunber of fistulas,relation with anal sphincter and complicating abscess were observed.The scale mark of probe next to anal verge was regarded as the distance from the lesion to the anal verge.Clock localization of lithotomy position was use to marked the position of external opening and fistula;Parks classification was used to describe the relation among fistula,puborectal muscle and internal/external sphincter.Ultrasound examination results were compared with enhanced MRI examination results and surgical results.The diagnosis value of 360°-TRUS combined with high-frequency ultrasonography in internal opening and fistula of anal fistula was summarized,whether 360°-TRUS combined with high-frequency ultrasonography can replace MRI in clinical was judged.Results:1 Preoperative diagnosis of internal openingby 360°-TRUS:Among the 32 patients,46 internal openings were confirmed by surgical results,33 were diagnosed by 360°-TRUS before the surgery with the diagnostic accuracy rate of 71.7%(33/46),41 were diagnosed by MRI before the surgery with the diagnostic accuracy rate of 89.1%(41/46).Through chi-square test,there was statistical difference in the preoperative diagnosis of internal opening between 360°-TRUS and MRI(P<0.05).The accuracy rate of MRI was higher than that of 360°-TRUS.The two examinations have a certain clinical value in the preoperative diagnosis of internal opening.2 Preoperative diagnosis of fistula by 360°-TRUS combined with high-frequency ultrasonography: Among the 32 patients,61 fistulas were confirmed by surgical results,46 were diagnosed with 360°-TRUS combined with high-frequency ultrasonography before the surgery with the diagnostic accuracy rate of 75.4%(46/61),55 were diagnosed MRI with fistulas before the surgery with the diagnostic accuracy rate of 90.2%(55/61).Through chi-square test,there was statistical difference in the diagnosis of fistula between 360°-TRUS combined with high-frequency ultrasonography and MRI(P<0.05).The accuracy rate of MRI was higher.The two examinations have high accuracy in the diagnosis of fistula before anal fistula operation.3 Preoperative diagnosis of fistula type by 360°-TRUS combined with high-frequency ultrasonography:Compared wich surgical results,the accuracyrates offistula types diagnosed by 360°-TRUS combined with high-frequency ultrasonography were as follows: intersphincteric100%(5/5),transsphincteric 95.6%(22/23),suprasphincteric 33.3%(1/3),extrasphincteric 0(0/1);the accuracyrates of fistula types diagnosed by MRI were as follows: intersphincteric80%(4/5),transsphincteric 86.9%(20/23),suprasphincteric 100%(3/3),extrasphincteric 100%(1/1).The accuracy rates of intersphincteric and transsphincteric diagnosed by 360°-TRUS combined with high-frequency ultrasonography were higher,the accuracy rates of suprasphincteric and extrasphincteric diagnosed by MRI were higher.The two examinations have distinctive advantages in the preoperative diagnosis of different fistula type.4 Preoperative diagnosis of abscess by 360°-TRUS:Among the 32 patients,seven abscesses were confirmed by surgical results,five were diagnosed by 360°-TRUS before the surgery,seven were diagnosed by MRI before the surgery.Through chi-square test,there was no statistical difference in the diagnosis of anal fistula abscess between 360°-TRUS and MRI(P>0.05).The two examinations have distinctive advantages in the preoperative diagnosis of abscess.Conclusion: 1 Perianal tissue structure,Internal anal and adjacent structures can be displayed clearly by 360°-TRUS combined with high-frequency ultrasonography.It shows external opening and internal opening of anal fistula,fistula trace and the relation with anal sphinctervisually,which can provide important information for the diagnosis and treatment of anal fistula,especially the choice of operative patterns.2 360°-TRUS combined with high-frequency ultrasonography can be applied as a routine preoperative examination of anal fistula in clinical.As for the doubtful case by ultrasound examination,enhanced MRI is used to improve the diagnosis accuracy of preoperative localization of anal fistula.