Application of 3D-HRAM model in diagnosis and localization of anal sphincter injury after surgery for complex anal fistula

Wu Xuxiong; Xu Limei; Huang Juan; Yang Yaling; Wang Zhaochu; Liang Ruiwen; Shi Rong

doi:10.13406/j.cnki.cyxb.003641

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Application of 3D-HRAM model in diagnosis and localization of anal sphincter injury after surgery for complex anal fistula

Clinical research | 更新时间：2025-10-22

- Application of 3D-HRAM model in diagnosis and localization of anal sphincter injury after surgery for complex anal fistula
- Journal of Chongqing Medical University Vol. 50, Issue 6, Pages: 821-827(2025)
- 作者机构：
  
  1.福建中医药大学附属人民医院肛肠科，福州 350004
  2.福建中医药大学附属人民医院超声影像科，福州 350004
  3.福建中医药大学第一临床医学院，福州 350000
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.003641
  CLC： R619
- Received：16 May 2024，
  
  Revised：2024-08-20，
  
  Accepted：10 October 2024，
  
  Published：28 June 2025
- 稿件说明：
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吴许雄,徐丽美,黄娟,等.3D-HRAM模型诊断及定位复杂性肛瘘术后肛门括约肌损伤的应用研究[J].重庆医科大学学报,2025,50(6):821-827.

Wu Xuxiong,Xu Limei,Huang Juan,et al.Application of 3D-HRAM model in diagnosis and localization of anal sphincter injury after surgery for complex anal fistula[J].Journal of Chongqing Medical University,2025,50(6):821-827.
吴许雄,徐丽美,黄娟,等.3D-HRAM模型诊断及定位复杂性肛瘘术后肛门括约肌损伤的应用研究[J].重庆医科大学学报,2025,50(6):821-827. DOI： 10.13406/j.cnki.cyxb.003641.

Wu Xuxiong,Xu Limei,Huang Juan,et al.Application of 3D-HRAM model in diagnosis and localization of anal sphincter injury after surgery for complex anal fistula[J].Journal of Chongqing Medical University,2025,50(6):821-827. DOI： 10.13406/j.cnki.cyxb.003641.

摘要

目的

探讨三维高分辨肛门直肠压力测定（three-dimensional high-resolution anorectal manometry，3D-HRAM）模型诊断及定位复杂性肛瘘术后肛门括约肌损伤的应用价值。

方法

前瞻性纳入2023年1月至2024年1月福建中医药大学附属人民医院肛肠科复杂性肛瘘术后患者92例为研究对象，分两阶段进行研究。第一阶段将92例患者均行3D-HRAM及直肠腔内超声（endoanal ultrasonography，EAUS）检查，检测括约肌信息，与术中记录对比，评估二者诊断效能及定位准确性。第二阶段将已检测的92例患者按伴/不伴肛门功能障碍症状分组，进一步评估2种检测方法对于术后括约肌损伤代偿/失代偿病例的诊断及定位价值。

结果

92例患者经3D-HRAM诊断括约肌损伤41例，敏感度为61.19%，特异度为88%，绘制受试者工作特征（receiver operating characteristic，ROC）曲线计算曲线下面积（area under the curve，AUC）为0.739，定位准确率为44.77%；经EAUS诊断57例，敏感度为85.07%，特异度为76%，AUC为0.813，定位准确率为71.64%，二者对比差异有统计学意义（

=0.002），提示3D-HARM对复杂性肛瘘术后括约肌损伤的诊断效能和定位准确率均低于EAUS。通过症状分组后，3D-HRAM对于有症状的括约肌损伤（失代偿）病例的诊断效能及定位准确率明显优于无症状组，而与EAUS相似（

=0.763）。

结论

3D-HRAM的应用优势在于诊断及定位复杂性肛瘘术后肛门括约肌损伤失代偿的病例，可为肛门控便机制及损伤代偿机制的研究提供有效技术支持。

Abstract

Objective

To explore the application value of three-dimensional high-resolution anorectal manometry（3D-HRAM） model in the diagnosis and localization of anal sphincter injury after surgery for complex anal fistula.

Methods

A prospective study was conducted on 92 patients who had undergone surgery for complex anal fistula in the Department of Coloproctology of The People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January 2023 to January 2024. The study was conducted in two stages. In the first stage，92 patients underwent 3D-HRAM and endoanal ultrasonography（EAUS） to examine the sphincter，and the data were compared with intraoperative records to evaluate the diagnostic efficiency and localization accuracy of 3D-HRAM and EAUS. In the second stage，92 patients who had been examined were grouped according to the presence or absence of symptoms of anal dysfunction to further verify the diagnostic and localization values of 3D-HRAM and EAUS for postoperative compensated/decompensated sphincter injury.

Results

Among 92 patients，41 and 57 patients were diagnosed with sphincter injury through 3D-HRAM and EAUS，with a sensitivity of 61.19% and 85.07%，a specificity of 88% and 76%，an area under the curve of 0.739 and 0.813 calculated by plotting the receiver operating characteristic curve，and a localization accuracy of 44.77% and 71.64%，respectively，showing significant differences between 3D-HRAM and EAUS（

=0.002），indicating that 3D-HRAM had lower diagnostic efficiency and localization accuracy than EAUS for anal sphincter injury after surgery for complex anal fistula. After grouping by symptoms，the diagnostic efficiency and localization accuracy of 3D-HRAM for symptomatic sphincter injury（decompensated） were significantly better than those for asymptomatic sphincter injury，and were similar to those of EAUS（

=0.763）.

Conclusion

The application advantage of 3D-HRAM lies in the diagnosis and localization of decompensated anal sphincter injury after surgery for complex anal fistula，which provides effective technical support for the study of anal defecation control mechanisms and injury compensation mechanisms.

关键词

Keywords

references

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Establishment and evaluation of risk prediction model of anal incontinence after complex anal fistula surgery

Related Author

Wu Xiaojing

Shi Rong

Wu Xuxiong

Liang Ruiwen

Wang Jing

Chen Zuqing

Huang Juan

Related Institution

Anorectal Department， The People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine

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