肛瘘的影像学研究进展
Advances in Imaging Studies of Anal Fistula
DOI: 10.12677/jcpm.2026.53201, PDF,    科研立项经费支持
作者: 杜杨彪*, 王麒雅, 唐浠桡, 雷 娟, 邓文轩, 胡 芳#：湘南学院医学影像检验与康复学院，湖南 郴州；湘南学院，山东乐润信息技术有限公司医学影像技术专业校企合作创新创业教育基地，湖南 郴州；张盛甫：湘南学院，山东乐润信息技术有限公司医学影像技术专业校企合作创新创业教育基地，湖南 郴州；郴州市肛瘘和肛周脓肿诊疗技术研发中心，郴州市第一人民医院，湖南 郴州；广州中医药大学第一附属医院影像科，广东 广州；罗宏标：湘南学院，山东乐润信息技术有限公司医学影像技术专业校企合作创新创业教育基地，湖南 郴州；郴州市肛瘘和肛周脓肿诊疗技术研发中心，郴州市第一人民医院，湖南 郴州
关键词: 肛瘘；影像诊断；人工智能；Anal Fistula； Imaging Diagnosis； Artificial Intelligence
摘要: 肛瘘(Anal fistula, AF)是肛肠外科常见的难治性疾病，其中的复杂性肛瘘占肛瘘患者的33.5%，具有较高的复发率及严重的并发症风险。其病因涉及隐窝腺体感染、解剖变异及克罗恩病等特殊病理机制，临床上常表现为多个外口、高位瘘管及反复流脓，非常容易影响患者生活质量。本文就近年来肛瘘的表现、影像学诊断进展进行综述，重点分析各类技术的优势与局限性，以及AI在肛瘘诊疗中的作用和展望。
Abstract: Anal fistula (AF) is a common refractory disease in anorectal surgery, with complex anal fistulas accounting for 33.5% of cases, characterized by a high recurrence rate and a risk of severe complications. Its etiology involves specific pathological mechanisms such as crypt gland infection, anatomical variation and Crohn’s disease. Clinically, it often manifests as multiple external openings, high-level fistulas, and recurrent purulent discharge, significantly impacting patients’ quality of life. This article infestations and recent advances in imaging diagnosis of anal fistulas, focusing on the advantages and limitations of various techniques, as well as the role and prospects of artificial intelligence in the DND treatment of anal fistulas.
文章引用：杜杨彪, 王麒雅, 唐浠桡, 雷娟, 邓文轩, 张盛甫, 罗宏标, 胡芳. 肛瘘的影像学研究进展[J]. 临床个性化医学, 2026, 5(3): 206-215. https://doi.org/10.12677/jcpm.2026.53201

参考文献

[1] Ren, J., Bai, W., Gu, L., Li, X., Peng, X. and Li, W. (2023) Three-Dimensional Pelvic Ultrasound Is a Practical Tool for the Assessment of Anal Fistula. BMC Gastroenterology, 23, Article No. 134. [Google Scholar] [CrossRef] [PubMed]
[2] Charalampopoulos, A., Papakonstantinou, D., Bagias, G., Nastos, K., Perdikaris, M. and Papagrigoriadis, S. (2023) Surgery of Simple and Complex Anal Fistulae in Adults: A Review of the Literature for Optimal Surgical Outcomes. Cureus, 15, e35888. [Google Scholar] [CrossRef] [PubMed]
[3] Zhu, X., Zhu, T., Ye, D. and Liu, S. (2020) Magnetic Resonance Imaging Findings of Carcinoma Arising from Anal Fistula: A Retrospective Study in a Single Institution. World Journal of Clinical Cases, 8, 5159-5171. [Google Scholar] [CrossRef] [PubMed]
[4] 郑妍, 王建民. 复杂性肛瘘诊断的影像学研究进展[J]. 中医药临床杂志, 2017, 29(12): 2005-2009.
[5] 王倩, 邹贤军. 克罗恩病肛瘘的外科诊治现状[J]. 临床外科杂志, 2023, 31(6): 521-523.
[6] Li, M., Fang, X., Zhang, J. and Deng, H. (2022) Internal Orifice Alloy Closure—A New Procedure to Treat Anal Fistula. Frontiers in Surgery, 9, Article 881060. [Google Scholar] [CrossRef] [PubMed]
[7] Deng, H., Li, M., Fang, X., Zhang, J., Wang, J., Tang, K., et al. (2023) Evaluation of the Mechanical Properties and Clinical Application of Nickel-Titanium Shape Memory Alloy Anal Fistula Clip. Frontiers in Surgery, 10, Article 1235666. [Google Scholar] [CrossRef] [PubMed]
[8] La Torre, M., Goglia, M., Micarelli, A., Fiori, E., D’Andrea, V., Grossi, U., et al. (2023) Long Term Results of Video‐assisted Anal Fistula Treatment for Complex Anal Fistula: Another Shattered Dream? Colorectal Disease, 25, 2017-2023. [Google Scholar] [CrossRef] [PubMed]
[9] Garg, P. (2022) Comparison between Recent Sphincter-Sparing Procedures for Complex Anal Fistulas-Ligation of Intersphincteric Tract vs Transanal Opening of Intersphincteric Space. World Journal of Gastrointestinal Surgery, 14, 374-382. [Google Scholar] [CrossRef] [PubMed]
[10] 张雷. 肛瘘是怎么形成的[J]. 家庭百事通, 2025(4): 36-38.
[11] 朱静怡, 张玲, 何笠, 等. 复杂性肛瘘内口病理特征和局部黏膜微生物群落特征的初探[J]. 结直肠肛门外科, 2023, 29(1): 53-61.
[12] Ji, L., Zhang, Y., Xu, L., Wei, J., Weng, L. and Jiang, J. (2021) Advances in the Treatment of Anal Fistula: A Mini-Review of Recent Five-Year Clinical Studies. Frontiers in Surgery, 7, Article 586891. [Google Scholar] [CrossRef] [PubMed]
[13] Włodarczyk, M., Włodarczyk, J., Maryńczak, K., Waśniewska-Włodarczyk, A., Dziki, Ł. and Fichna, J. (2024) The Impact of Adipose Fat Tissue on the Pathogenesis of Crypto-Glandular Anal Fistula. Polish Journal of Surgery, 96, 12-17. [Google Scholar] [CrossRef] [PubMed]
[14] Fan, Y., Yu, Z., Xu, C., Wang, J. and Hu, T. (2024) A Surgical Resection of Giant Perianal Mass Secondary to Complex Anal Fistula: A Case Report. Journal of Surgical Case Reports, 2024, rjae514. [Google Scholar] [CrossRef] [PubMed]
[15] Wang, Y., Wang, Y., Jia, X., Yan, Q. and Zheng, X. (2024) High Complex Anal Fistula Managed by the Modified Transanal Opening of the Intersphincteric Space via the Inter-Sphincteric Approach: A Case Report. World Journal of Radiology, 16, 552-560. [Google Scholar] [CrossRef] [PubMed]
[16] Kim, H.C. and Simianu, V.V. (2024) Contemporary Management of Anorectal Fistula. Surgery Open Science, 17, 40-43. [Google Scholar] [CrossRef] [PubMed]
[17] Arkenbosch, J.H.C., van Ruler, O., de Vries, A.C., van der Woude, C.J. and Dwarkasing, R.S. (2025) The Role of MRI in Perianal Fistulizing Disease: Diagnostic Imaging and Classification Systems to Monitor Disease Activity. Abdominal Radiology, 50, 589-597. [Google Scholar] [CrossRef] [PubMed]
[18] Liang, C., Wu, Y., Wang, L., Bai, J., Wang, D. and Zhao, F. (2025) Adoption of Enhanced Multislice Spiral Computed Tomography Combined with Magnetic Resonance Imaging in Staging and Preoperative Assessment of Colon Cancer Patients. Bio-Medical Materials and Engineering, 36, 279-286. [Google Scholar] [CrossRef] [PubMed]
[19] 肖高力, 张娟, 李琰. 多层螺旋CT三维重建与瘘管造影在复杂性肛瘘诊断中的临床价值[J]. 生命科学仪器, 2025, 23(2): 50-52.
[20] 刘汉舟, 胡金灵. 螺旋CT三维重建技术在基层医院复杂性肛瘘诊断中的价值[J]. 医学信息, 2023, 36(4): 105-107.
[21] 王志涛, 鲁振锋. CT瘘管造影及三维重建在复杂性肛瘘中的应用价值探讨[J]. 浙江医学, 2021, 43(2): 227-230.
[22] 刘杰, 王峰, 董玉龙, 等. 多层螺旋CT联合三维重建技术诊断复杂性肛瘘的效果[J]. 中国医学创新, 2019, 16(21): 110-113.
[23] 吴建东, 李俊华. 复杂性肛瘘的CT、MRI诊断价值分析[J]. 影像研究与医学应用, 2023, 7(12): 182-184.
[24] Gou, B., Zhang, J., Chen, L., Xin, F., Zhou, J., Xu, Q., et al. (2022) Comparison of the Diagnostic Accuracy of Percutaneous Fistula Contrast-Enhanced Ultrasound Combined with Transrectal 360° 3-D Imaging and Conventional Transrectal Ultrasound in Complex Anal Fistula. Ultrasound in Medicine & Biology, 48, 2154-2161. [Google Scholar] [CrossRef] [PubMed]
[25] 许辉, 孔德伟. MRI增强检查在复杂性肛瘘诊断中的价值研究[J]. 中国医药科学, 2022, 12(15): 142-146.
[26] 杨海艳. 高频超声结合经肛管超声在肛周脓肿和肛瘘中的诊断价值[J]. 影像研究与医学应用, 2025, 9(2): 174-176.
[27] Thuong Vu, L., Minh Duc, N., Tra My, T., Tan Lien Bang, M., Tuan Linh, L. and Quynh Huong, T. (2021) Congenital Bronchobiliary Fistula: A Case Report and Literature Review. Respirology Case Reports, 9, e00731. [Google Scholar] [CrossRef] [PubMed]
[28] 杨军, 张志轶, 沈文龙, 等. 经会阴三维超声检查联合Sonazoid瘘管造影对肛瘘的诊断价值医学影像学杂志[J]. 2024, 34(11): 105-108.
[29] Chang, C., Qiao, L., Zhang, Z., Tian, X., Zhang, Y., Cheng, W., et al. (2025) High-resolution Direct Magnetic Resonance Imaging Fistulography with Hydrogen Peroxide for Diagnosing Anorectal Fistula: A Preliminary Retrospective Study. World Journal of Radiology, 17, Article ID: 101221. [Google Scholar] [CrossRef] [PubMed]
[30] Karmakar, R., Gupta, D., Mukundan, A. and Wang, H. (2025) Hydrogen Peroxide-Enhanced Magnetic Resonance Imaging: A Novel Approach for Diagnosing Anorectal-Fistula. World Journal of Radiology, 17, Article ID: 105777. [Google Scholar] [CrossRef] [PubMed]
[31] 谢林, 胡浩清, 费维, 等. 经肛周二维及三维超声联合瘘管造影在合并肛门狭窄的肛瘘患者中的临床应用价值[J]. 中国中西医结合影像学杂志, 2022, 20(4): 364-369.
[32] 王军大, 崔渺, 李艳艳, 等. MRI钆剂瘘管造影与DCE-MRI联合使用对高位复杂型肛瘘细小分支瘘管及瘘口的诊断价值[J]. 重庆医科大学学报, 2018, 43(01): 60-65.
[33] 石峰, 高原, 王昕, 等. MRI在肛瘘诊断及Parks分型中的应用价值[J]. 中国CT和MRI杂志, 2023, 21(10): 155-158.
[34] 张敏怡, 唐平, 任德圣, 等. MRI在复杂性肛瘘术前诊断中的应用价值[J]. 中国CT和MRI杂志, 2024, 22(10): 136-137.
[35] 黄捷敏, 石荣. 磁共振成像在复杂性肛瘘诊疗中的研究进展[J/OL]. 中医临床研究: 1-5.
https://link.cnki.net/urlid/11.5895.r.20241226.1116.004, 2026-06-04.
[36] Tao, Q., Tang, Y., Luo, Y., Li, D., Lu, R., Zheng, Z., et al. (2024) Comparison of Multi-Phase Contrast-Enhanced T1-Weighted Volumetric Interpolated Breath-Hold Examination and Fat-Suppressed T2-Weighted Combined with Diffusion-Weighted Magnetic Resonance Imaging in Anal Fistula Evaluation. Quantitative Imaging in Medicine and Surgery, 14, 8629-8643. [Google Scholar] [CrossRef] [PubMed]
[37] Liu, J., Zhang, T. and Sheng, L. (2024) A Controlled Study of MR DWI, FS-PDW, and CE-T1W Imaging for the Evaluation of the Internal Opening of Anal Fistulas. Acta Radiologica, 65, 1319-1324. [Google Scholar] [CrossRef] [PubMed]
[38] 杨来华, 刘建岭, 尹利飞, 等. MRI肛瘘影像图谱在临床诊断中的应用探讨[C]//重庆市健康促进与健康教育学会全科专委会. 2025精神医学与心理健康系列研讨会论文集. 2025: 1574-1578.
[39] 万赵伟. MRI在复杂性肛瘘诊断及分型中的应用[J]. 现代医用影像学, 2024, 33(11): 2116-2118.
[40] Lu, W., Li, X., Liang, W., Chen, K., Cao, X., Zhou, X., et al. (2024) Dynamic Contrast-Enhanced MR Imaging in Identifying Active Anal Fistula after Surgery. BMC Medical Imaging, 24, Article No. 76. [Google Scholar] [CrossRef] [PubMed]
[41] Xu, H., Xiao, G., Zheng, Y., Fu, Y., Zhong, S., Ren, D., et al. (2023) A Magnetic Resonance Imaging-Based Decision-Making Tool for Predicting Complex Anal Fistulas Healing in the Early Postoperative Period. BMC Gastroenterology, 23, Article No. 372. [Google Scholar] [CrossRef] [PubMed]
[42] 黄捷敏, 石荣. 磁共振成像在复杂性肛瘘诊疗中的应用研究进展[J]. 中医临床研究, 2024, 16(36): 113-117.
[43] 徐新庭. DWI-MRI联合DCE-MRI对肛瘘的诊断价值[J]. 医学信息, 2023, 36(18): 171-174.
[44] Aggarwal, P., Malik, R., Sarawagi, R. and Kumar, A. (2024) Comparing the Efficacy of a Combination of Diffusion-Weighted Imaging and T2-STIR (Short Tau Inversion Recovery) Imaging with Contrast-Enhanced MRI in the Evaluation of Perianal Fistula. Cureus, 16, e53485. [Google Scholar] [CrossRef] [PubMed]
[45] Inggriani, S., Rahmawati, D.L. and Octavius, G.S. (2025) A Systematic Review and Meta-Analysis of the Diagnostic Test Accuracy of Diffusion Weighted Imaging and Apparent Diffusion Coefficient in Differentiating Active from Inactive Perianal Fistula. Radiography, 31, Article ID: 102884. [Google Scholar] [CrossRef] [PubMed]
[46] 王玉, 谷超, 丁承宗, 等. DTI评价肛瘘活动性的可行性研究[J]. 中国中西医结合影像学杂志, 2018, 16(6): 582-584, 590.
[47] 刘佳伟, 郝金钢, 刘灿丽. MRI在肛管直肠瘘中的应用进展[J]. 影像科学与光化学,2024, 42(3): 187-191.
[48] Kummari, S., Burra, K.G., Reddy, V.R.K., Das, S., Ramadugu, R. and Ramadugu, S. (2024) The Role of Magnetic Resonance Imaging in Pre-Operative Assessment of Anorectal Fistula with Surgical Correlation. Cureus, 16, e53237. [Google Scholar] [CrossRef] [PubMed]
[49] Zhao, W.W., Yu, J., Shu, J., et al. (2023) Precise and Comprehensive Evaluation of Perianal Fistulas, Classification and Related Complications Using Magnetic Resonance Imaging. American Journal of Translational Research, 15, 3674-3685.
[50] Huang, K., Garuba, F., Ganapathy, A., Bishop, G., Zhang, H., Lovato, A., et al. (2024) Quantifying 18F-Fluorodeoxyglucose Uptake in Perianal Fistulas on PET/CT: A Retrospective Analysis. Academic Radiology, 31, 2775-2783. [Google Scholar] [CrossRef] [PubMed]
[51] Navkar, N.V., Balakrishnan, S., Kharbech, S., Sabawi, M., Abinahed, J., Ahmed, A., et al. (2022) 3D Visualization of Perianal Fistulas Using Parametric Models. Techniques in Coloproctology, 26, 291-300. [Google Scholar] [CrossRef] [PubMed]
[52] 袁军, 陈欣悦, 常时新, 等. 基于T1增强成像的人工智能算法在肛瘘内口诊断中的可行性研究[J]. 安徽医药, 2023, 27(3): 447-452.
[53] 吴许雄, 徐丽美, 黄娟, 等. 3D-HRAM模型诊断及定位复杂性肛瘘术后肛门括约肌损伤的应用研究[J]. 重庆医科大学学报, 2025, 50(6): 821-827.
[54] Greer, M.C. and Taylor, S.A. (2022) Perianal Imaging in Crohn Disease: Current Status with a Focus on MRI, from the AJR Special Series on Imaging of Inflammation. American Journal of Roentgenology, 218, 781-792. [Google Scholar] [CrossRef] [PubMed]
[55] Bitschi, D., Fürmetz, J., Gilbert, F., Jörgens, M., Watrinet, J., Pätzold, R., et al. (2023) Preoperative Mixed-Reality Visualization of Complex Tibial Plateau Fractures and Its Benefit Compared to CT and 3D Printing. Journal of Clinical Medicine, 12, Article 1785. [Google Scholar] [CrossRef] [PubMed]
[56] Jeri‐McFarlane, S., García‐Granero, Á., Ochogavía‐Seguí, A., Pellino, G., Oseira‐Reigosa, A., Gil‐Catalan, A., et al. (2023) Three‐Dimensional Modelling as a Novel Interactive Tool for Preoperative Planning for Complex Perianal Fistulas in Crohn’s Disease. Colorectal Disease, 25, 1279-1284. [Google Scholar] [CrossRef] [PubMed]
[57] Han, L., Chen, Y., Cheng, W., Bai, H., Wang, J. and Yu, M. (2021) Deep Learning-Based CT Image Characteristics and Postoperative Anal Function Restoration for Patients with Complex Anal Fistula. Journal of Healthcare Engineering, 2021, Article ID: 1730158. [Google Scholar] [CrossRef] [PubMed]