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 localization of MRI in complex anal fistula surgery

目的:探讨术前磁共振成像检查(MRI)定位技术对复杂性肛瘘手术的临床应用价值。方法:收治复杂性肛瘘患者56例,随机平分两组。试验组手术前使用MRI检查定位技术对其瘘管走向和内口情况进行观察,术中根据MRI检查结果进行手术。对照组术中利用亚甲蓝染色技术对患者的瘘管走向和内口情况进行观察。以最终的手术结果为标准,对患者的肛瘘内口、支管和脓腔以及肛门括约肌关系的术前诊断准确率进行判断,比较两组治疗效果的差异。结果:利用术前MRI检查定位技术对患者肛瘘与肛门括约肌关系、肛瘘内口、脓腔和隐藏支管进行诊断的准确率分别为96.43%、92.31%、96.00%;试验组临床治愈率92.86%,对照组75.00%,差异有统计学意义(P<0.05);试验组6个月后复发率7.14%,对照组28.57%,差异有统计学意义(P<0.05)。结论:复杂性肛瘘手术前,利用MRI检查定位技术对患者的肛瘘内口、脓腔和隐藏支管进行定位可以有效降低手术过程中不必要的肌肉损伤,且利用该技术进行术前检查,可以明确瘘管与肛门括约肌之间的关系,并在一定程度上降低肛瘘的复发率。

Objective:To explore the clinical value of preoperative magnetic resonance imaging(MRI)localization technique in complex anal fistula surgery.Methods:56 patients with complex anal fistula were selected,they were randomly divided into two groups equally,In the experimental group,the MRI examination and positioning technique was used to observe the direction of the fistula and the internal port,the operation was performed according to the MRI results.In the control group,methylene blue staining technique was used to observe the patient's fistula trend and internal orifice.Based on the final surgical results,the preoperative diagnostic accuracy of the relationship between the internal orifice of anal fistula,the branch and the pus cavity,and the anal sphincter was judged,and the difference of therapeutic effect between the two groups was compared.Results:The accuracy of preoperative MRI examination and localization technique for the diagnosis of anal fistula and anal sphincter,anal fistula,abscess and concealed branch were 96.43%,92.31%,and 96.00%,respectively.The clinical cure rate of the experimental group was 92.86%,and the control group was 75.00%,the difference was statistically significant(P<0.05).The recurrence rate was 7.14% in the experimental group and 28.57% in the control group after 6 months,the difference was statistically significant(P<0.05). Conclusion:Before the operation of complex anal fistula,the use of MRI examination and positioning technique to locate the anal fistula,abscess and concealed branch of the patient can effectively reduce unnecessary muscle damage during the operation,and using this technique for preoperative examination,the relationship between the fistula and the anal sphincter can be clarified,and the recurrence rate of the anal fistula can be reduced to some extent.