肛管直肠环有限元模型建立及在规范挂线疗法治疗肛瘘中的生物力学仿真研究

Good anal function is the key to the evaluation of anal fistula surgery success. In case of the anal function injury induced by direct incision in the anorectal ring fistula, surgeons usually choose the TCM(traditional Chinese medicine) seton therapy relying on their clinical experience. Most research on this field focus on the anatomy and function of perianal muscle, while the biomechanical mechanisms of the dysporia induced by the anorectal ring damage are rarely concerned based on the entity model.In our study we plan to integrate the three-dimensional anorectal ultrasound and MR into imitating and reconstructing the three-dimensional finite element anorectal ring model of postoperation of anal fistula surgery.From multi views ( the rest image, the elevating anus image, forcibly bowel movement image, e.g.), multi levels (overall function evaluation and assessment of the damage to the local tissue), and visualization (stress nephogram), we can study the changes of the anorectal ring biomechanics occurred on different plysiological states (on rest,and on maximum abdominal pressure), different impaired regions and varying degrees of damage.As a result, we can find the relativity of the anorectal ring damage and the anal function, determine the thickness and the security range of the anorectal ring incision, and clarify the biomechanical mechanism of the dysporia induced by anorectal ring damage in the treatment of anal fistula. By all the work mentioned above, we wish to provide a new platform for studying the TCM seton therapy in anal fistula treatment.

良好的肛门功能是评价肛瘘手术成功与否的关键。为避免直接切开穿越肛管直肠环的瘘管导致肛门功能损伤，手术医师多凭临床经验采用中医挂线疗法，研究亦偏重肛周肌肉形态解剖学及功能学临床研究,对肛管直肠环损伤造成的控便障碍的生物力学机制尚未有研究。本课题在前期治疗肛瘘术后肛门肌肉缺损临床研究基础上，拟采用三维肛管直肠超声及MR结合,模拟重建肛瘘术后肛管直肠环三维有限元模型，并进行有限元模型分析，多角度（静息像、提肛像、力排像）、多层次（整体功能评价、局部组织受损评估）、可视化（应力云图）相结合仿真研究肛管直肠环有限元模型在不同生理状态（静息、最大腹压）不同点位受损、不同程度损伤的生物力学仿真变化，总结肛管直肠环损伤与肛门功能的相关性，确定肛管直肠环切开厚度、点位的安全范围，阐明肛管直肠环损伤在肛瘘治疗中发生控便障碍的生物力学机制，为临床深入研究并规范中医挂线疗法在肛瘘治疗中的应用范围提供一个新平台。