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肛瘘是常见的肛周感染性疾病,治疗以手术为主,术前手术方案制定的关键是准确定位内口及判断瘘管的数量及走形,以争取最大限度降低对肛管功能的损伤及复发率。Goodsall规律在很多外科书中被用来定位肛瘘内口,地方很多医院临床医生不做影像学检查,而仅仅根据Goodsall规律来判断内口进行手术,结果造成不必要的肛管括约肌的损伤,严重者会导致大便失禁等。本研究通过分析Goodsall规律预测肛瘘内口、超声探查肛瘘内口与手术探查结果的一致性,评估Goodsall规律预测肛瘘内口、超声定位内口的有效性,旨在临床应用中充分利用好超声检查,不要盲目依据Goodsall规律预测的内口来考虑手术方案,造成医源性损伤。现作报道。
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Goodsall规律预测内口与手术内口位置符合率87.1%,一致性检验Kappa值为0.657,具有较强一致性(P < 0.01)(见表 1)。
手术内口位置 Goodsall规律预测内口位置 合计 定位(+) 定位(-) 定位(+) 48 5 53 定位(-) 4 13 17 合计 52 18 70 Kappa 0.657 — P < 0.01 — 表 1 Goodsall规律预测与手术内口位置一致性检验
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超声探查内口位置与手术内口位置符合率88.6%,一致性检验Kappa值为0.676,具有较强一致性(P < 0.01)(见表 2)。
手术内口位置 超声内口位置 合计 定位(+) 定位(-) 定位(+) 50 3 53 定位(-) 5 12 17 合计 55 15 70 Kappa 0.676 — P < 0.01 — 表 2 超声与手术探查内口位置一致性检验
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浅表皮下瘘12条,括约肌间瘘43条,经括约肌瘘10条,括约肌上瘘2条,马蹄形瘘3条。
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Goodsall规律对浅表皮下型、括约肌间型肛瘘内口预测与超声探查符合率90.1%,对经括约肌型、马蹄形及括约肌上型肛瘘内口预测符合率46.9%,未探查到括约肌外型肛瘘。Goodsall规律预测内口位置与超声探查内口位置一致性检验Kappa值为0.486,具有中等一致性(P < 0.05)(见表 3)。
Goodsall规律预测内口位置 超声内口位置 合计 定位(+) 定位(-) 定位(+) 47 5 52 定位(-) 8 10 18 合计 55 15 70 Kappa 0.486 — P < 0.05 — 表 3 Goodsall规律预测与超声探查内口位置一致性检验
Goodsall规律预测与经直肠双平面腔内超声定位肛瘘内口的价值比较
Comparison of the value of the Goodsall rule and biplane transrectal ultrasonography in positioning the internal opening of anal fistula
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摘要:
目的评估Goodsall规律预测肛瘘内口、经直肠双平面超声定位肛瘘内口的价值。 方法回顾性分析行手术治疗的肛瘘病人52例(70条肛瘘)临床资料, 每例病人术前均根据Goodsall规律预测肛瘘内口, 同时行经直肠双平面超声探查内口, 并与手术探查结果进行一致性检验比较。 结果Goodsall规律预测与手术符合率87.1%, 一致性检验Kappa值为0.657, 具有较强一致性(P < 0.01)。超声探查内口和手术诊断符合率88.6%, 一致性检验Kappa值为0.676, 具有较强一致性(P < 0.01)。70条肛瘘超声探查结果: 浅表皮下瘘12条, 括约肌间瘘43条, 经括约肌瘘10条, 括约肌上瘘2条, 马蹄形瘘3条。Goodsall规律对浅表皮下型、括约肌间型肛瘘内口预测与超声探查符合率较高(90.1%), 对经括约肌型、马蹄形及括约肌上型肛瘘内口预测符合率不高(46.9%), 一致性检验Kappa值为0.486, 具有中等一致性(P < 0.05)。 结论Goodsall规律预测肛瘘内口与手术或经直肠双平面超声具有高度一致性, 具有一定临床价值, 尤其对浅表皮下型瘘、括约肌间型瘘预测与超声符合率较高, 但在预测外口位于横线前的瘘管及马蹄形型、经括约肌型、括约肌上型瘘内口位置有一定局限性; 超声探查及临床治疗中可将Goodsall规律与经直肠双平面超声有效结合, 提高诊断及治疗效果。 -
关键词:
- 肛瘘 /
- 经直肠双平面超声 /
- Goodsall规律
Abstract:ObjectiveTo evaluate the value of the Goodsall rule in predicting internal opening of anal fistula and the value in locating the internal opening of anal fistula using biplane transrectal ultrasonog raphy. MethodsThe clinical data of 52 patients(70 anal fistulas) who underwent surgical treatment were retrospectively analyzed.The internal opening of anal fistula of each patient was predicted according to the Goodsall rule before surgery, and the internal fistula was simultaneously explored by biplane transrectal ultrasonography.Both results were compared with surgical exploration results via a consistency test. ResultsThe consistency rate of the Goodsall rule and operation diagnosis was 87.1%, and the Kappa value in the consistency test was 0.657, showing strong consistency(P < 0.01).The consistency rate of ultrasonic exploration and surgical diagnosis was 88.6%, and the Kappa value in the consistency test was 0.676, showing strong consistency(P < 0.01).Results of ultrasonic exploration of 70 anal fistulas were listed as follows: 12 superficial subcutaneous fistulas, 43 intersphincteric fistulas, 10 transsphincteric fistulas, 2 superior sphincteric fistulas and 3 horseshoe fistulas.The Goodsall rule had a high coincidence with ultrasonic exploration for superficial subcutaneous, intersphincteric anal fistulas and ultrasonic probe(90.1%).However, the prediction rate of the Goodsall rule for the internal opening of transsphincter type, horseshoe type, and suprasphincter type was not high(46.9%), and the Kappa value of consistency test was 0.486, showing moderate consistency(P < 0.05). ConclusionsThe value of the Goodsall rule in predicting the internal opening is highly consistent with surgery or biplane transrectal ultrasonography, showing a certain clinical value, especially for superficial subcutaneous fistula and intersphincteric anal fistulas, whereas there are some limitations in predicting the location of fistulas in front of the transverse line and the internal opening of horseshoe, transsphincter, and suprachincter fistulas.In ultrasound examination and clinical treatment, the Goodsall rule can be effectively combined with biplane transrectal ultrasonography to improve the diagnosis and treatment effect. -
Key words:
- anal fistula /
- biplane transrectal ultrasonography /
- Goodsall rule
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表 1 Goodsall规律预测与手术内口位置一致性检验
手术内口位置 Goodsall规律预测内口位置 合计 定位(+) 定位(-) 定位(+) 48 5 53 定位(-) 4 13 17 合计 52 18 70 Kappa 0.657 — P < 0.01 — 表 2 超声与手术探查内口位置一致性检验
手术内口位置 超声内口位置 合计 定位(+) 定位(-) 定位(+) 50 3 53 定位(-) 5 12 17 合计 55 15 70 Kappa 0.676 — P < 0.01 — 表 3 Goodsall规律预测与超声探查内口位置一致性检验
Goodsall规律预测内口位置 超声内口位置 合计 定位(+) 定位(-) 定位(+) 47 5 52 定位(-) 8 10 18 合计 55 15 70 Kappa 0.486 — P < 0.05 — -
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