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Objective:To investigate the clinical effect of transsphincter fistulectomy in the treatment of anal fistula.Methods:Seventy-three patients with anal fistula who received treatment in Zhoushan Hospital from March 2016 to March 2020 were included in this study. They were randomly assigned to undergo either conventional incision combined with thread-drawing drainage (control group, n = 35) or transsphincter fistulectomy (observation group, n = 38). Operative time, wound healing time, length of hospital stay, Visual Analogue Scale (VAS) score 24 and 48 hours after surgery, complications, the improvement in anal sphincter function before and 3 months after surgery were compared between the two groups. Results:Operative time, wound healing time and length of hospital stay in the observation group were (49.83 ± 7.67) minutes, (20.78 ± 3.54) days and (5.31 ± 1.27) days, which were significantly shorter than those in the control group [(62.31 ± 5.45) minutes, (25.87 ± 3.10) days, (7.78 ± 1.32) days, t = 8.063, 6.512, 8.133, all P < 0.05). The VAS score 24 and 48 hours after surgery in the observation group were (2.43 ± 0.64) points and (1.21 ± 0.36) points, respectively, which were significantly lower than those in the control group [(3.87 ± 1.23) points, (2.83 ± 0.97) points, t = 6.347 and 9.607, both P < 0.05]. The incidence of complication in the observation group was significantly lower than that in the control group [5.26% (2/38) vs. 28.57% (10/35), χ2 = 7.206, P < 0.05]. Conclusion:Transsphincter fistulectomy in the treatment of anal fistula has good therapeutic effects, can reduce pain and has little impact on the function of anal sphincter. It is innovative and scientific.
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Objective:To assess the change rules of fetal cervical, thoracic and lumbar spinal volume and centrum volume with gestational ages.Methods:The 3.0 T MRI was performed on 55 fetal specimens ranging from 17 to 42 gestational weeks with sequence of three dimensional T 2WI. Among 55 samples, 20 samples were obtained from spontaneous abortion of pregnant women and 35 samples were obtained from induced labor of mothers due to serious diseases. The fetal specimen was derived from sectional imaging anatomy research institute of the medical school of Shandong University. No spinal abnormalities were found on CT scans. The cervical, thoracic and lumbar spinal volume was obtained by delineating the vertebral body contour on the reconstructed cross-sectional image with the OsiriX software (www.osirix-viewer.com). And the volume of the cervical, thoracic and lumbar spine was divided by the number of the vertebral bodies to obtain the centrum unit volume. Five lumbar vertebral bodies were measured one by one. Regression analysis was made between the volume of cervical, thoracic and lumbar spine and gestational weeks, and between the volume of lumbar vertebral bodies and gestational weeks to analyze the growth rule of spine. Results:(1) The cervical, thoracic and lumbar spine volume increased linearly with gestational ages, and the linear regression equation was as follows: cervical spine volume (mm 3) =-1 260.937+81.235×gestational week ( R2=0.974, P<0.05), thoracic spine volume (mm 3) =-5 933.521+347.503×gestational week ( R2=0.972, P<0.05), lumbar spine volume (mm 3) =-5 130.912+294.473×gestational week ( R2=0.976, P<0.05). (2) The order from large to small of fetal spinal growth rate was thoracic, lumbar and cervical segment. Within the same gestational age, the order from large to small of spinal volume was thoracic, lumbar and cervical segment. The order from large to small of centrum unit volume growth rate was lumbar, thoracic and cervical vertebrae. (3) The volume of each lumbar vertebral body also increased linearly with gestational age. Conclusion:The cervical, thoracic and lumbar volume show a good correlation with the gestational weeks in the second and third trimester fatal specimens, and the growth rate of different segments is different.
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ObjectiveTo study the morphology, normal values and lateral asymmetry of Chinese calcarine sulcus on MRI. Methods High-resolution and transverse MRI were obtained from 40 female volunteers. Brainvisa software was used to reconstruct the calcarine sulcus and measure its average length, depth and width automatically. Results The posterior branch of calcarine sulcus showed six types in the median sagittal plane: bifurcation(32.50%), single peak(25.00%), flat (16.25%), S-shaped (15.00%), double peak(7.50%) and other shape (3.75%); its location had three types: inferior(72.50%), middle(21.25%)and superior(6.25%). The depth of left calcarine sulcus was (15.24±2.67)mm, and the right one was (16.97±3.25)mm, which revealed great statistical significance (P＜0.000 1). The width of left calcarine sulcus was (3.14±0.91)mm, and it was (3.19± 0.83)mm in the right side. The bottom length of calcarine sulcus: the left was (86.47±16.85)mm, the right was (83.62±17.10)mm. The top length of calcarine sulcus: the left was (70.52±12.40)mm, the right was (64.90±15.17)mm. There were not statistical significance in width, bottom length and top length between left and right calcarine sulci. More than half of the end part of calcarine sulci turned to the lateral surface of cerebral hemisphere.Totally 63 cases (78.75%) were found with prominent calcar avis. Conclusion Significant difference of depth between left and right calcarine sulcus of female was found. Three-dimensional reconstruction is an effective method to study the anatomy of calcarine sulcus.
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Objective To study the developmental process of the region of basal nuclei of postmortem fetuses by 3.0 T and 7.0 T MRI.Methods One hundred and thirty-one postmortem fetuses of 14 to 40 weeks of gestational age(GA)were scanned by 3.0 T MR,of which 11 fetuses of 14-27 weeks of GA were chosen and scanned by 7.0 T MR. The time when the structures in the region of basal nuclei could be detected and the changes of MR signal intensity were analyzed for MRI of different Tesla.Results On 3.0 T MRI.the dorsal thalamus could be delineated as early as 14 weeks of GA. The germinal matrix, caudate nucleus,and putamen could be visualized as early as 15 weeks of GA. The globus pallidus could be described as early as 18 weeks of GA.and the internal capsule and external capsule could be shown as early as 20 weeks of GA. The signal of the caudate nucleus during 15-30 weeks of GA was relatively hypointense on T1WI and hyperintense on T2WI.but during 31-40 weeks of GA, it was relatively hyperintense on T1WI and hypointense on T2WI. The putamen had a relatively high signal intensity on T1WI and low signal intemity on T1WI during 15-17 weeks of GA, and it appeared patchy during 18-25 weeks of GA,then it had a relatively low signal intensity on T1WI and high signal intensity on T2WI during 26-30 weeks of GA, and during 31-40 weeks of GA,its signal intensity was relatively high on T1WI and low on T2WI.The globus pallidus had a relatively high signal intensity on T1WI and low signal intensity on T2WI during 20-40 weeks of GA Compared to the 3.0 T MRI,the T2 images of 7.0 T MRl were more clear,and most structures in the region of basal nuclei could be clearly displayed as early as 16 weeks of GA.such as the germinal matrix,caudate nucleus,dorsal thalamus,putamen,globus pallidus,internal capsule,and external capsule.The claustrum could be delineated as early as 18 weeks of GA on 7.0 T MRI. Conclusions 3.0 T MRI could show the developmental process of the region of basal nuclei well,but the T2 images of 7.0 TMRl were comparatively better.
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Objective To investigate the morphology and relationships with the adjacent structures in the pineal region on the thin sections and to provide anatomic data for imaging diagnosis and surgical treatment of diseases in this region. Methods By CT and MRI examination, one normal head specimen was selected for this study. Using the computerized freezing milling technique, the specimen was sliced from anterior to posterior. The in vivo MR images were obtained from ten normal Chinese male adult volunteers using a 3.0 T GE scanner. The base lines of the sectioning and the MR scan were perpendicular to the AC-PC line. Then primary sections were contrasted with the corresponding MR images. Results By the appearance of the pineal peduncle and the disappearance of the pineal gland, the pineal region could be divided into three parts from anterior to posterior, and the shape changed from an inverted triangle to a trapezoid and a triangle gradually. The first interspace was getting wider in the anterior and middle parts of the pineal region, while in the posterior part of the pineal region, it was getting narrower and disappeared finally. From anterior to posterior, the bilateral internal cerebral veins were always in the midline of the pineal region and descended gradually.Conclusion By the computerized freezing milling technique, the anatomic details and adjacent relationships of the pineal region could be exhibited clearly in the thin serial sections, which could help the imaging diagnosis and surgical treatments for minute diseases in this region.
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Objective To study the capability of high field MRI in demonstrating the post-mortem fetal brains at different gestational age(GA).Methods One hundred and eight post-mortem fetal brains of 14-40 weeks GA were evaluated by 3.0 T MRI. Eleven brains of 14 to 27 weeks GA with good 3.0 T MRI images were chosen and scanned by 7.0 T MRI. The developing sulci, layered structures of fetal cerebral cortex and basal nuclei were evaluated on MRI of different Tesla(3.0 T and 7.0 T)and their results analyzed. Results On T_1 WI of 3.0 T MRI, the layered structures of fetal cerebral cortex were present at 14 weeks GA, the sulci were more accurately identified after 16 weeks GA. The basal nuclei were clearly distinguishable after 20 weeks GA. and these structures were better visualized as the GA increased. On T_2WI of 7.0 T MRI, the sulei, layered structures of fetal cerebral cortex and basal nuclei were shown more clearly at the same GA when compared to 3.0 T, especially the sulci at the early developmental stages. Conclusions T_1 WI of 3.0 T MRI could show the developing structures of post-mortem fetal brain well, but the T_2 WI of 7.0 T MRI were comparatively better.
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Objective To evaluate neurovascular anatomical relationship in patients with trigeminal neuralgia.Methods 49 patients with neuralgia were examined by MRI 3D-CISS in combination with 3D-TOF and MPR technique.The MRI findings were compared to the partial operative results.Results 13 patients who underwent surgery were considered as a responsible compression of vessel on 3D-CISS and 3D-TOF imaging,the compression caused by artery and vein was seen in operation in 10 cases and 3 cases respectively.18 (90%) of 20 patients with the symptom of maxillary division had neurovascular compression at the medial site of the root of trigeminal nervus,while 15(79%) of 19 patients with the symptom of mandibular division had compression at the lateral site.Conclusion 3D-CISS MR imaging is useful in the detection of neurovascular relationship and correlation between the region of neuralgic manifestation and the site of trigeminal nerve compression.
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Objective KG1This study is to evaluate defectography in postoperative defecation function of Hirschsprung′s disease (HD). KG2MethodsKG1 Between 1979 and 1993, 30 HD cases were treated operatively and followed-up by defectography. KG2ResultsKG1 Thirty cases were classified into 3 groups, according to the standard quantitative clinical scoring systems with the stooling score from 0 to 14. There were 4 cases (13%) graded as excellent (maximum score of 14) with normal bowel habit, 21 cases (70%) as good (score between 10～13) with minor continence problems, 5 cases (16 7%) as fair (score between 5～9) with marked limitations in social life. Anorectal manometry study showed that the anal resting pressure and voluntary sphincter force (maximal queeze pressure minus resting pressure) in fair group were significantly lower than that in control group( P