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Abstract：
Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and explored methods for improving the preoperative diagnostic accuracy of fistulas in males with ARMs after colostomy.
A retrospective analysis was performed on males with ARMs after colostomy admitted to our hospital from January 2015 to June 2022. All patients underwent magnetic resonance imaging (MRI) and high-pressure colostogram (HPC) before anorectal reconstruction. Patients with no fistula as diagnosed by both modalities underwent a voiding cystourethrogram (VCUG). General information, imaging results and surgical results were recorded.
Sixty-nine males with ARMs after colostomy were included. Age at the time of examination was 52 ~ 213 days, and the median age was 89 days. The Krickenbeck classification according to surgical results included rectovesical fistula (n = 19), rectoprostatic fistula (n = 24), rectobulbar fistula (n = 19) and no fistula (n = 7). There was no significant difference in the diagnostic accuracy between MRI and HPC for different types of ARMs. For determining the location of the fistula, compared to surgery, HPC (76.8%, 53/69) performed significantly better than MRI (60.9%, 42/69) (p = 0.043). Sixteen patients diagnosed as having no fistula by MRI or HPC underwent a VCUG, and in 14 patients, the results were comfirmed. However, there were 2 cases of rectoprostatic fistula that were not correctly diagnosed.
High-pressure colostogram has greater accuracy than MRI in the diagnosis of fistula type in males with ARMs after colostomy. For patients diagnosed with no fistula by both methods, VCUG reduces the risk of false-negative exclusion, and rectoprostatic fistula should be considered during the operation.
A retrospective analysis was performed on males with ARMs after colostomy admitted to our hospital from January 2015 to June 2022. All patients underwent magnetic resonance imaging (MRI) and high-pressure colostogram (HPC) before anorectal reconstruction. Patients with no fistula as diagnosed by both modalities underwent a voiding cystourethrogram (VCUG). General information, imaging results and surgical results were recorded.
Sixty-nine males with ARMs after colostomy were included. Age at the time of examination was 52 ~ 213 days, and the median age was 89 days. The Krickenbeck classification according to surgical results included rectovesical fistula (n = 19), rectoprostatic fistula (n = 24), rectobulbar fistula (n = 19) and no fistula (n = 7). There was no significant difference in the diagnostic accuracy between MRI and HPC for different types of ARMs. For determining the location of the fistula, compared to surgery, HPC (76.8%, 53/69) performed significantly better than MRI (60.9%, 42/69) (p = 0.043). Sixteen patients diagnosed as having no fistula by MRI or HPC underwent a VCUG, and in 14 patients, the results were comfirmed. However, there were 2 cases of rectoprostatic fistula that were not correctly diagnosed.
High-pressure colostogram has greater accuracy than MRI in the diagnosis of fistula type in males with ARMs after colostomy. For patients diagnosed with no fistula by both methods, VCUG reduces the risk of false-negative exclusion, and rectoprostatic fistula should be considered during the operation.
摘要：
背景：准确的术前瘘诊断对男性结肠造口术后肛门直肠畸形（ARM）具有重要意义。我们回顾了我们的机构经验，并探索了提高结肠造口术后有ARM的男性瘘管术前诊断准确性的方法。
方法：对我院2015年1月至2022年6月收治的男性结肠造口术后ARMs患者进行回顾性分析。所有患者在肛门直肠重建前均接受了磁共振成像（MRI）和高压结肠造影（HPC）。通过两种方式诊断为无瘘管的患者接受了排尿膀胱尿道造影（VCUG）。一般信息,记录影像学结果和手术结果。
结果：纳入了结肠造口术后有ARM的69例男性。检查时的年龄为52~213天，中位年龄为89天。根据手术结果的Krickenbeck分类包括直肠膀胱瘘（n=19），直肠前列腺瘘（n=24），球直肠瘘（n=19）和无瘘（n=7）。MRI和HPC对不同类型的ARM的诊断准确性差异无统计学意义。与手术相比，HPC（76.8%，53/69）的表现明显优于MRI（60.9％，42/69)(p=0.043)。通过MRI或HPC诊断为无瘘管的16例患者接受了VCUG，在14名患者中，结果得到确认。然而,有2例直肠前列腺瘘未正确诊断。
结论：在结肠造口术后有ARM的男性瘘管型诊断中，高压结肠造影比MRI具有更高的准确性。对于通过两种方法诊断为无瘘管的患者，VCUG降低了假阴性排除的风险，术中考虑直肠前列腺瘘。
方法：对我院2015年1月至2022年6月收治的男性结肠造口术后ARMs患者进行回顾性分析。所有患者在肛门直肠重建前均接受了磁共振成像（MRI）和高压结肠造影（HPC）。通过两种方式诊断为无瘘管的患者接受了排尿膀胱尿道造影（VCUG）。一般信息,记录影像学结果和手术结果。
结果：纳入了结肠造口术后有ARM的69例男性。检查时的年龄为52~213天，中位年龄为89天。根据手术结果的Krickenbeck分类包括直肠膀胱瘘（n=19），直肠前列腺瘘（n=24），球直肠瘘（n=19）和无瘘（n=7）。MRI和HPC对不同类型的ARM的诊断准确性差异无统计学意义。与手术相比，HPC（76.8%，53/69）的表现明显优于MRI（60.9％，42/69)(p=0.043)。通过MRI或HPC诊断为无瘘管的16例患者接受了VCUG，在14名患者中，结果得到确认。然而,有2例直肠前列腺瘘未正确诊断。
结论：在结肠造口术后有ARM的男性瘘管型诊断中，高压结肠造影比MRI具有更高的准确性。对于通过两种方法诊断为无瘘管的患者，VCUG降低了假阴性排除的风险，术中考虑直肠前列腺瘘。
