摘要
目的探讨磁共振成像（MRI）检查在先天性肛门直肠畸形诊断中的临床应崩价值。方法回顾性分析我院2008年5月至2012年5月经手术治疗并确诊的先天性肛门直肠畸形患儿44例，男25例，女19例，年龄1d～2岁。患儿术前均行MRI检查。结果44例先天性肛门直肠畸形中高位肛门闭锁的15例，占34％，直肠盲端位于耻尾线（Pc线，耻骨直肠肌环水平）上方，直肠盲端与肛门窝距离为（29．12±2．35）mm；中位闭锁的8例，占18％，直肠盲端位于Pc线附近，直肠肓端与肛门窝距离为（18．98±2．21）mm；低位闭锁的21例，占48％，直肠肓端位于Pc线下方，直肠盲端与肛门窝距离为（7．54±1．08）nlm。44例中伴有瘘管25例，占57％，其中会阴瘘14例，膀胱瘘6例，尿道瘘2例，阴道瘘2例，阴囊根部体表瘘1例，均经直肠造影及手术证实。MRI可以清晰的显示其中13例瘘管，其余12例瘘管MRI显示不明确或未见显影。44例中，脊髓栓系并终丝脂肪瘤1例，单纯脊髓栓系1例，脊髓空洞2例，右肾缺如1例，睾丸鞘膜积液1例。44例MRI多平面成像可以清晰的显示肛周肌群发育情况，其中36例肛周肌群存在发育异常，表现为肛提肌、耻骨直肠肌及肛门括约肌两侧不对称、肌腹纤细。结论MRI在先天性肛门直肠畸形诊断中具有很高的临床应用价值，可以准确的判断肛门闭锁类型，显示大部分瘘管的存在及走行；诊断肛周肌群发育情况及其他系统畸形，为手术方案的制定及预后的评估提供可靠的诊断依据。
Objective To investigate the clinical value of MRI examination in congenital anorectal malformation （CARM）. Method Forty-four cases with operatively proved anoreetal malformation from May 2008 to May 2012 in the authors＇hospital were reviewed. Of the 44 cases, 25 were males and 19 females, their age ranged from 1 day to 2 years. MRI was performed in all patients. Result Of all 44 cases, 15 cases had high imperforate anus （34%） , rectum blind end were above PC line, the distance of rectum blind end and anus nest was （29. 12±2.35） mm; 8 cases had median imperforate anus （18%） , rectum blind ends were near PC line, the distance of rectum blind end and anus nest was （18. 98±2. 21 ）mm; 21 cases had low imperforate anus （48%） , rectum blind ends were below PC line, the distance of rectum blind end and anus nest was （7.54± 1.08） mm. Twenty-five cases with fistula in 44 cases were confirmed by rectal angiography and surgery accounting for 57% . In 13 cases with fistula, the lesion could be clearly demonstrated on MRI, in the remaining 12 cases with fistula, the lesion could not be visualized clearly or no image development occurred on MRI. Of all 44 cases, 1 case had tethered cord with filum terminale lipoma, 1 case had tethered cord, 2 cases had syringomyelia, 1 case had right kidney agenesis, 1 case had hydrocele. In 44 cases of multi-planar MRI imaging could clearly show the perianal muscles developmental situation, 36 cases had perianal muscles dysplasia, amd showed levator ani muscle, puborectalis and anal sphincter asymmetry, muscle belly slim. Conclusion MRI examination has a high clinical value in CARM diagnosis, can help accurately judge the anal atresia type, display the presence and running of most of the fistula, and diagnose perianal muscle development and other systems malformations, finally provide a reliable diagnostic basis for surgical program and prognostic assessment.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2014年第1期41-45,共5页
Chinese Journal of Pediatrics
关键词
儿童
磁共振成像
肛门直肠畸形
Child
Magnetic resonance imaging
Anorectal malformation
