术前MRI定位技术应用于复杂性肛瘘手术的临床研究

Clinical study of preoperative MRI positioning technology applied in complex anal fistula operation

目的探讨术前MRI定位技术应用于复杂性肛瘘手术的临床价值。方法随机抽选在本院确诊的200例复杂性肛瘘患者,采用随机数字表法分为试验组(n=100)和对照组(n=100),试验组术前采用MRI定位技术确定瘘管走向、内口等情况,术中根据MRI结果进行手术,对照组术前未采用MRI定位,术中采用亚甲蓝染色技术确定瘘管走向、内口等情况进行手术。以手术结果为标准,观察MRI定位方法对肛瘘内口、支管和脓腔以及与肛门括约肌关系的术前诊断准确率。比较两组手术治疗效果的差异。结果以手术结果为标准,MRI术前对肛瘘与肛门括约肌关系的诊断准确率为95.0%,对肛瘘内口的诊断准确率为91.7%(88/96),对支管和脓腔的诊断准确率为95.0%(76/80)。试验组临床治愈率为93%,显著高于对照组的76%,差异有统计学意义(χ2=9.773,P=0.002);试验组6个月后复发率为5%,明显低于对照组的19%,差异有统计学意义(χ2=8.002,P=0.005)。结论术前MRI定位技术能明确瘘管与肛门括约肌之间的关系,准确找到肛瘘内口、脓腔和隐藏支管,术前采用MRI定位可有效减少不必要的肌肉损伤,降低肛瘘的复发率。

Objective To explore the clinical value of preoperative MRI positioning technology applied in complex anal fistula operation.Methods 200 eases of patients diagnosed with complex anal fistula in our hospital were randomly se- lected and divided into experimental group （n=100） and control group （n=100） by the random number table method, preoperative MRI positioning technology was given to the experimental group to determine the fistula direction and en- dostoma,operated based on MRI results;control group were not given with preoperative MRI positioning technology and operated according to the methylene blue staining technique to determine the fistula direction and endostoma.The operation results were as the standard.The preoperative diagnostic accuracy of MRI positioning on endostoma of anal fistula, branch pipe,pus cavity and the relationship with the anal sphincter was observed.The difference on surgical effects be- tween the two groups was compared.Results The operation results were as the standard.The preoperative diagnostic accuracy of MRI positioning on the relationship between anal fistula and anal sphincter was 95.0%;on the endostoma of anal fistula,the accuracy was 91.7% （88/96）,and 95.0% （76/80） on branch pipe and pus cavity.The clinical cure rate of experimental group was 93%,significantly higher than 76% of the control group,the difference was significant （χ^2=9.773, P=-0.002）.After 6 months,the recurrence rate was 5% in experimental group,was obviously lower than 19% of the control group,the difference was significant （χ^2=8.002,P=0.005）.Conclusion Preoperative MRI positioning technology can clear the relationship between anal fistula and the anal sphincter,and pinpoint the anal fistula endostoma,pus cavity and the hidden inside pipe.The preoperative MRI positioning can effectively reduce the unnecessary muscle injury and the recurrence rate of anal fistula.