Morris分型和Freiburger分型在肛瘘术前评估中的应用价值分析——基于MRI成像  

Analysis of the application value of Morris classification and Freiburger classification in preoperative evaluation of anal fistula based on MRI imaging

作　　者：李晓艳 谭志军 赵宝平 韩晨晨 闫秀秀 杜滂 Li Xiaoyan;Tan Zhijun;Zhao Baoping;Han Chenchen;Yan Xiuxiu;Du Pang(Department of Radiology,Xi’an Daxing Hospital,Xi’an,Shaanxi 710000,China;Department of Statistics,Air Force Medical University,Xi’an,Shaanxi 710000,China)

机构地区：[1]西安大兴医院影像科,陕西西安710000 [2]空军军医大学统计学教研室,陕西西安710000

出　　处：《结直肠肛门外科》2024年第4期471-476,共6页Journal of Colorectal & Anal Surgery

基　　金：西安大兴医院院内科研项目(KY-20240003)。

摘　　要：目的基于MRI成像分析并比较Morris分型及Freiburger分型在肛瘘术前评估中的应用价值。方法选择2022年1月1日至2024年1月31日在西安大兴医院确诊为肛瘘的162例患者作为研究对象,患者均行肛瘘手术,并于术前一周内行MRI平扫及DWI扫描。所有患者的MRI图像均采用Morris分型及Freiburger分型评估主瘘管、脓肿;查阅手术记录,采用前述两种分型评估相应的主瘘管、脓肿。将基于MRI成像诊断结果与手术诊断结果进行Kappa一致性检验,并绘制森林图。结果Morris分型1~5级及总的诊断符合率分别为97.4%、93.5%、100%、86.9%、76.2%、88.7%。Freiburger分型FⅠ~FⅥ及总的诊断符合率依次为95.6%、91.3%、90.7%、90.4%、60.0%、83.3%、87.1%;Freiburger分型AⅠ~AⅣ及总的诊断符合率均为100%、100%、90.0%、97.0%、97.3%。基于MRI成像诊断和手术诊断的Morris分型的Kappa值为0.853,95%CI为0.794~0.912,P<0.001;基于MRI成像诊断和手术诊断的Freiburger分型总的Kappa值为0.918,95%CI为0.887~0.948,P<0.001;根据瘘管(F)诊断的Kappa值为0.838,95%CI为0.778~0.898,P<0.001;根据脓肿(A)诊断的Kappa值为0.982,95%CI为0.957~1.000,P<0.001。结论与Morris分型相比,肛瘘Freiburger分型对瘘管的诊断效能相当;此外,Freiburger分型对复杂性肛瘘及脓肿的诊断具有独特而显著的优势,可以更有效地指导手术计划。Objectives To compare the application value of Morris classification and Freiburger classification in preoperative evaluation of anal fistula based on MRI imaging.Methods A total of 162 patients diagnosed with anal fistula at Xi’an Daxing Hospital from January 1,2022,to January 31,2024,were enrolled in this study.All patients underwent anal fistula surgery and underwent MRI plain scan and DWI scan within one week before surgery.MRI images of all patients were evaluated for primary fistulas and abscesses using both Morris classification and Freiburger classification.Surgical records were reviewed,and the corresponding primary fistulas and abscesses were assessed using the aforementioned two classifications.The Kappa consistency test was performed between the MRI-based diagnostic results and surgical diagnostic results,and a forest plot was drawn.Results The diagnostic coincidence rates for Morris classification grades 1 to 5 and overall were 97.4%,93.5%,100%,86.9%,76.2%,and 88.7%,respectively.The diagnostic coincidence rates for Freiburger classification FⅠto FⅥand overall were 95.6%,91.3%,90.7%,90.4%,60.0%,83.3%,and 87.1%,respectively.The diagnostic coincidence rates for Freiburger classification AⅠto AⅣand overall were 100%,100%,90.0%,97.0%,and 97.3%,respectively.The Kappa value for Morris classification based on MRI imaging diagnosis and surgical diagnosis was 0.853,with a 95%CI of 0.794 to 0.912(P<0.001).The overall Kappa value for Freiburger classification based on MRI imaging diagnosis and surgical diagnosis was 0.918,with a 95%CI of 0.887 to 0.948(P<0.001).Among them,the Kappa value for fistula(F)diagnosis was 0.838,with a 95%CI of 0.778 to 0.898(P<0.001),and the Kappa value for abscess(A)diagnosis was 0.982,with a 95%CI of 0.957 to 1.000(P<0.001).Conclusion Compared with Morris classification,Freiburger classification of anal fistula has equivalent diagnostic efficacy for fistulas.Additionally,it demonstrates unique and significant advantages in the diagnosis of complex anal fistulas and abscesse

关 键 词：肛瘘 Morris分型 Freiburger分型 

分 类 号：R657.1[医药卫生—外科学]