多模态超声在肛瘘诊断与预后预测中的研究进展

Research Progress of Multimodal Ultrasound in the Diagnosis and Prognosis Prediction of Anal Fistula

摘要: 肛瘘作为肛肠外科常见疾病，因其解剖结构复杂、病变走行多样及术后复发率较高，术前精准评估及术后动态监测对优化治疗方案和改善预后具有重要意义。近年来，多模态超声(multiparametric ultrasound, MPUS)通过整合经肛/经直肠超声、三维超声、超声造影、超声弹性成像及经会阴超声等多种成像技术，从形态结构、血流灌注及组织力学特性等维度对肛瘘进行综合评估，显著提升了肛瘘诊断及预后预测能力。现有研究表明，多模态超声在肛瘘Parks分型、内口定位、复杂分支瘘管及脓肿检出方面具有较高准确性，并可通过评估炎症活动性、纤维化程度及残余病灶状态，为术后复发风险预测、括约肌功能评估及愈合过程动态监测提供客观影像学依据。本文围绕多模态超声在肛瘘诊断与预后预测中的研究进展进行综述，以期为肛瘘精准诊疗和个体化管理提供参考。

Abstract: As a common disease in colorectal surgery, anal fistula is characterized by complex anatomical structure, diverse lesion pathways and a high postoperative recurrence rate. Preoperative accurate evaluation and postoperative dynamic monitoring are of great significance for optimizing treatment regimens and improving clinical prognosis. In recent years, multiparametric ultrasound (MPUS), by integrating multiple imaging techniques including transanal/transrectal ultrasound, three-dimensional ultrasound, contrast-enhanced ultrasound, ultrasound elastography and transperineal ultrasound, conducts comprehensive evaluation of anal fistula from dimensions including morphology and structure, blood perfusion and tissue mechanical properties, which significantly improves the capacity of anal fistula diagnosis and prognosis prediction. Existing studies have demonstrated that MPUS achieves high accuracy in Parks classification of anal fistula, localization of internal openings, detection of complex branched fistulae and abscesses. Moreover, by evaluating inflammatory activity, fibrosis degree and the status of residual lesions, MPUS can provide objective imaging evidence for postoperative recurrence risk prediction, sphincter function assessment and dynamic monitoring of the healing process. This article reviews the research progress of MPUS in the diagnosis and prognosis prediction of anal fistula, aiming to provide reference for the precise diagnosis and individualized management of anal fistula.