三维直肠腔内超声结合耦合剂造影对肛周坏死性筋膜炎的手术指导价值

李玲华; 韩旭; 张雪琴; 华校琨; 李春玲

doi:10.12259/j.issn.2095-610X.S20240322

三维直肠腔内超声结合耦合剂造影对肛周坏死性筋膜炎的手术指导价值

doi: 10.12259/j.issn.2095-610X.S20240322

1.
昆明市中医医院肛肠科，云南昆明　650011

基金项目: 昆明市卫生健康委员会卫生科研基金资助项目（2022-09-02-004）

详细信息

作者简介:
李玲华（1986～），女，云南玉溪人，医学学士，主治医师，主要从事超声在肛肠疾病的诊断研究工作

通讯作者:
李春玲，E-mail：624438552@qq.com

中图分类号: R445.1
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出版历程
- 收稿日期: 2023-12-07
- 网络出版日期: 2024-03-11
- 刊出日期: 2024-03-30

Value of Three-dimensional Rectal Intraluminal Ultrasound Combined with Couplant Contrast for Surgical Guidance of Perianal Necrotising Fasciitis

1.
Dep.t of Anus and Intestine Surgery，Kunming Hospital of Traditional Chinese Medicine，Kunming Yunnan 650011，China

摘要

摘要: 目的探讨三维直肠腔内超声结合耦合剂造影在肛周坏死性筋膜炎的手术指导价值。方法对40例临床诊断为肛周坏死性筋膜炎的患者，同一病例术前均进行常规三维直肠腔超声检查（常规组）和耦合剂造影检查（造影组）2种检查，分别观察原发灶内口，深、浅筋膜坏死及肛提肌损伤情况，与手术结果对比，分析常规组和造影组观察内容诊断敏感性。结果常规组和造影组2种方法相比较，对原发灶内口显示率由70% 增加到97.5% ；深筋膜坏死显示率由50%增加到 88．8% ；浅筋膜显示率由70% 增加到 100% ；肛提肌损伤显示率由62.5% 增加到 97.2%（P < 0.05）。结论三维直肠腔内超声结合耦合剂造影较常规三维直肠腔超声对肛周坏死性筋膜炎原发灶内口，深、浅筋膜坏死，肛提肌损伤检出准确率显著提高，有利于指导临床医生制定最佳的手术方式，提高手术成功率。
- 坏死性筋膜炎 /
- 直肠腔内超声 /
- 耦合剂 /
- 造影
Abstract: Objective To explore the application value of Three-Dimensional rectal cavity ultrasound combined with contrast agent imaging in necrotizing fasciitis of the anal region. Methods Before surgery, standard three-dimensional rectal cavity ultrasound examinations（referred to as the conventional group） and contrast agent imaging examinations（referred to as the imaging group） were conducted for 40 patients clinically diagnosed with anal region necrotizing fasciitis. Separate observations were made for the primary lesion, as well as for the depth and superficial necrosis of the fascia, and injuries to the anal sphincter muscle. Comparative analysis with surgical results was undertaken to assess the diagnostic sensitivity of both the conventional and imaging groups. Results In comparing the conventional group with the imaging group, the rates of primary lesion visibility rose significantly from 70% to 97.5%, deep fascial necrosis visibility increased from 50% to 88.8%, superficial fascia visibility improved from 70% to 100%, and the visibility of anal sphincter muscle injury escalated from 62.5% to 97.2%, all demonstrating statistical significance at P < 0.05. Conclusions Three-dimensional rectal cavity ultrasound combined with contrast agent imaging exhibits significantly enhanced accuracy in identifying primary lesions associated with perianal necrotizing fasciitis, as well as the necrosis affecting deep and superficial fascia, in contrast to conventional three-dimensional rectal cavity ultrasound. This advancement offers more precise guidance for clinicians in devising surgical plans, thereby augmenting the success rate of surgical interventions.
- Necrotizing fasciitis /
- Rectal intracavitary ultrasound /
- Contrast agent /
- Imaging

HTML全文

图 1 常规腔内超声与造影腔内超声诊断肛周坏死性筋膜炎各项指标的图像

A：常规组腔内超声声像图，箭头所示为浅筋膜坏死；B：常规组腔内超声声像图，箭头所示分别为深筋膜坏死合并高位多间隙脓肿；C：造影组腔内超声声像图，箭头所示分别为浅筋膜坏死和原发灶内口；D：造影组腔内超声声像图，箭头所示分别为浅筋膜坏死、深筋膜坏死。

Figure 1. Images of parameters of perianal necrotizing fasciitis diagnosed by conventional and contrast-enhanced intracavitary ultrasonography.

下载: 全尺寸图片幻灯片

表 1 常规腔内超声与造影腔内超声在诊断肛周坏死性筋膜炎各项指标的显示率比较（%）

Table 1. Comparison of the display rate between conventional and contrast-enhanced intracavitary ultrasonography in the diagnosis of perianal necrotizing fasciitis （%）

检测项目	常规腔内超声显示率	造影腔内超声显示率	McNemar’s chi-squared	P
原发灶内口	70.0 （28/40）	97.5 （39/40）	9.091	0.003^*
深筋膜坏死	50.0 （18/36）	88.8 （32/36）	12.071	< 0.001^*
浅筋膜坏死	70.0 （28/40）	100 .0（40/40）	10.083	0.001^*
肛提肌受累	62.5 （20/36）	97.2 （35/36）	13.067	< 0.001^*
^*P < 0.05。

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