磁共振多模态序列结合临床指标对复杂性肛瘘术后肛门排粪失禁复发预测研究  

Multimodal Sequence of MRI Combined with Clinical Indicators to Predict the Recurrence of Anal Fecal Incontinence after Complex Anal Fistula Surgery

作　　者：朱寅虎 江泊源 李笑石 李馨 蒲豆豆 叶江海 秦越 ZHU Yin-hu;JIANG Bo-yuan;LI Xiao-shi;LI Xin;PU Dou-dou;YE Jiang-Hai;Qin Yue(Department of Radiology,Xi'an Daxing Hospital,Xi'an 710016,Shaanxi Province,China;Department of Medical Imaging,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,Shaanxi Province,China)

机构地区：[1]西安大兴医院影像科,陕西西安710016 [2]陕西中医药大学附属医院医学影像科,陕西咸阳712000

出　　处：《中国CT和MRI杂志》2024年第8期122-125,共4页Chinese Journal of CT and MRI

基　　金：陕西省重点研发计划项目(2023-YBSF-055)。

摘　　要：目的通过对多模态MRI指标与临床指标结合分析,建立复杂性肛瘘术后肛门排粪失禁预测模型,并对模型进行验证。方法回顾性分析2020年1月至2023年5月我院肛肠科收治的71例复杂性肛瘘患者资料。统计术后三个月是否有肛门失禁症状,根据肛门失禁进行分组,结合患者多模态MRI数据指标及临床指标等变量进行Logistic回归分析,建立术后肛门失禁预测模型。结果71例患者中,最终共纳入71人,其中男性65人,年龄21至63岁,平均年龄39.23±10.71岁,经括约肌型46例,括约肌上型25例。Logistic回归分析结果显示,MRI肛瘘分型、MRI病变直径、肛门外括约肌(exteral anal sphincter,EAS)萎缩分级、EAS厚度、年龄是复杂性肛瘘术后并发肛门失禁的独立危险因素(P<0.05)。依此进行因素筛选从而构建预测模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,曲线下面积(area under the curve,AUC)为0.940(P<0.001),模型预测质量评分0.87分,有较高的预测效能。结论MRI多模态成像指标结合临床风险因素建立的预测模型准确度良好,可以在治疗前方案的制订提供良好的影像学证据与参考,可以更好对肛门失禁情况进行提前预判。Objective To establish and validate a predictive model for recurrence of anal fecal incontinence after complex anal fistula surgery by combining magnetic resonance imaging(MRI)indicators with clinical indicators.Methods The data of 71 patients with complex anal fistula admitted to the Department of Anorectal surgery of our hospital from January 2020 to May 2023 were retrospectively analyzed.The symptoms and complications of anal incontinence at three months after operation were statistically analyzed.Univariate logistic regression analysis was performed combined with multimodal MRI data,clinical indicators,surgical methods and other variables.Results A total of 71 patients were included,including 65 males,aged from 21 to 63 years,with an average age of 39.23±10.71 years.There were 46 cases of trans-sphincteric type and 25 cases of suprasphincteric type.logistic regression analysis showed that MRI Anal fistula type,MRI lesion diameter,atrophy grade of Exteral Anal Sphincter(EAS),thickness of EAS and age were independent risk factors for postoperative anal incontinence after complex anal fistula surgery(P<0.05).The Receiver Operating Characteristic(ROC)Curve of the constructed prediction model was drawn,and the Area Under The Curve(AUC)was 0.940(P<0.001),and the prediction quality score of the model was 0.87,indicating that the model had a high prediction efficiency.Conclusion The prediction model established by combining MRI multimodal imaging indicators with clinical risk factors has good accuracy and can provide good imaging evidence and reference for the formulation of treatment plans before treatment.

关 键 词：复杂性肛瘘 肛门失禁 危险因素 LOGISTIC回归 受试者工作特征曲线 

分 类 号：R657.16[医药卫生—外科学]