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F Ⅰ～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 A Ⅰ～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.
Abstract
Objectives To compare the application value of Morris classification and Freiburger classification in preopera-tive 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 fis-tula 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 re-cords 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 diagnos-tic 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 FI to FⅥ and 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 A Ⅰ to AⅣ and 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 im-aging 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 abscesses,making it a more effective tool to guide surgical planning.
基金项目
西安大兴医院院内科研项目(KY-20240003)
国家科技期刊平台
NSTL
万方数据