磁共振检查对复杂性肛瘘手术治疗患者的指导价值及术后复发的危险因素分析

目的:探讨磁共振成像技术(MRI)对复杂性肛瘘诊断和术前评估的指导意义及术后复发的危险因素。方法:前瞻性选取2015年6月至2017年12月到我院诊断并接受手术治疗的359例复杂性肛瘘患者,将其随机分为观察组182例和对照组177例。对照组患者术前未行MRI检查,术中行亚甲蓝染色指导手术治疗。观察组术前行MRI检查,术中给予亚甲蓝染色结合术前评估行手术治疗,以术中探查结果为金标准,统计MRI术前检查复杂性肛瘘的准确率,Kappa检验评估MRI检查结果与术中探查结果的一致性,经1-2年的随访统计所有患者复发情况,单因素和多因素Logistic回归分析术后复发的危险因素。结果:观察组术中探查共发现瘘管内口281个,合并肛周脓肿57例,多发瘘管及支管151例,MRI术前检查瘘管内口、合并肛周脓肿、多发瘘管及支管的准确率分别为98.22%(276/281)、85.96%(49/57)、96.03%(145/151),观察组中MRI结果与术中探查结果对患者Parks分型通过一致性检验显示,两结果一致性较好(k=0.890,P=0.001)。单因素分析结果显示,肛瘘位置、内口位置、合并肛周脓肿、既往肛瘘手术史及术前是否行MRI检查均会影响复发率(均P0.05),Logistic回归多因素分析显示,术前未进行MRI检查、高位肛瘘、内口位于后正中线、既往肛瘘手术史是复杂性肛瘘术后复发的危险因素(均P0.05)。结论:MRI检查复杂性肛瘘能够术前明确瘘管及内口数量,可较为精确地识别瘘管Parks分型,有助于提高手术疗效,合并肛周脓肿、术前未进行MRI检查、高位肛瘘、内口位于后位、既往肛瘘手术史是复杂性肛瘘术后复发的危险因素。

The Guiding Value of Magnetic Resonance Imaging in the Treatment of Complex Anal Fistula and the Risk Factors of Postoperative Recurrence

ABSTRACT Objective: To explore the guiding significance of magnetic resonance imaging (MRI) in the diagnosis and preoperative evaluation of complex anal fistula and the risk factors for postoperative recurrence. Methods: 359 patients with complex anal fistula who were diagnosed and operated in our hospital were selected prospectively from June 2015 to December 2017. They were randomly divided into observation group with 182 cases and control group with 177 cases. In the control group, MRI was not performed before surgery, and methylene blue staining was performed intraoperatively to guide surgical treatment. The observation group received preoperative MRI examination, intraoperative methylene blue staining combined with preoperative evaluation for surgical treatment. Taking the results of intraoperative exploration as the gold standard, the accuracy of preoperative MRI examination for complex anal fistula was observed, the consistency of MRI examination results and intraoperative exploration results was evaluated by Kappa test. The recurrence status of all patients was counted through follow-up within 1-2 years, and risk factors of postoperative recurrence was analyzed by univariate and multivariate Logistic regression. Results: 281 fistulas were found in the observation group, 57 cases with crissum abscess, 151 cases with multiple fistula and branch pipe were found. MRI examination fistula in mouth, with crissum abscess, multiple fistula and branch pipe of accuracy was 98.22% (276/281), 85.96% (49/57), 96.03% (145/151), MRI in the observation group results for patients with intraoperative exploration results Parks, according to the classification by consistency check two results were in good consistency (k=0.890, P=0.001). Single factor analysis results show that the position of anal fistula, the location of internal orifice, merge crissum abscess, history of anal fistula operation and preoperative MRI check whether all can influence the recurrence rate (all P<0.05), Logistic regression analysis showed that multiple factors, not preoperative MRI check, high anal fistula, after the port was located in the posterior median line, history of anal fistula operation complexity anal fistula were risk factor for recurrence (all P<0.05). Conclusion: MRI examination of complex anal fistula can clarify the number of fistula and internal orifice before surgery, and identify fistula Parks more accurately, which is helpful to improve the surgical efficacy. Complicated perianal abscess, no MRI examination before surgery, high anal fistula, internal orifice in the posterior position, and previous history of anal surgery are risk factors for postoperative recurrence of complex anal fistula.