Method and system for regulating and controlling defecation function after ISR operation based on fMRI positioning

Abstract

The invention discloses a method and system for regulating and controlling the defecation function after ISR operation based on fMRI positioning, and the method comprises the following steps: S1, building a positioning model of fMRI anal sphincter movement; s2, through the constructed positioning model of the anal sphincter movement, an activation area related to the function of executing the anal sphincter movement is selected, and the cerebral cortex function area with the highest connection strength corresponding to the activation area serves as a regulation and control target; and S3, performing paired stimulation on the regulation and control target spots. Besides, a task-state magnetic resonance functional imaging technology is adopted to explore the activation state of the brain motor cortex during rectum and anal canal muscle movement, find functional nerve nuclei or pathways related to anal sphincter movement, accurately position the cortex functional area of the anal and rectum muscle group, and improve the accuracy of the anal and anal muscle group. Therefore, a new treatment scheme is sought for the rectum and anus function recovery of the patient with the low rectal tumor anus protection operation through the TMS.

Description

Technical Field

[0001] The present invention relates to the field of computer-aided diagnosis, particularly to the field of colorectal surgery assisted diagnosis, and more particularly to a method and system for positioning and regulating defecation function after ISR based on fMRI. Background Art

[0002] Colorectal cancer is the most common digestive tract malignant tumor worldwide, and its incidence and mortality rates are both among the top of malignant tumors. In recent years, with the improvement of surgical techniques, platform instruments, as well as the development of neoadjuvant therapy and immunotherapy, the sphincter preservation rate and survival rate of rectal cancer have been significantly improved. However, for low or ultra-low rectal cancer with the tumor located less than 5 cm from the anal verge, since a safe resection margin cannot be guaranteed, most patients still painfully choose to have their anus removed. How to achieve sphincter preservation while ensuring the thoroughness of low rectal cancer surgery is an extremely challenging problem in colorectal surgery.

[0003] Intersphincteric resection (ISR) is a sphincter-preserving surgery that has received much attention in recent years. Based on total mesorectal excision, this surgery further increases the distal resection margin and circumferential resection margin of the tumor by dissecting between the internal and external anal sphincters, enabling some low rectal cancer patients who could not have their sphincters preserved by traditional anterior resection to achieve sphincter preservation on the basis of radical resection, and is known as the ultimate sphincter-preserving surgery. With the wide popularity and increasing maturity of laparoscopic surgery, the sphincter-preserving strategy of excising the tumor through the intersphincteric space proposed by ISR surgery has become the focus of attention in colorectal surgery. ISR can partially replace traditional abdominoperineal resection to avoid permanent stoma, and the greatest risk is not the oncological outcome, but the impact of postoperative fecal incontinence on the quality of life of patients.

[0004] After anterior resection of low rectal cancer, defecation function disorders such as difficult defecation, tenesmus, frequent defecation, and fecal incontinence occur, which is called low anterior resection syndrome (LARS), and the incidence rate is as high as 60 - 90%. For the LARS symptoms that occur after low rectal cancer surgery, current clinical treatments are mostly empirical symptomatic treatments, and simply improving the reconstruction method cannot effectively improve the long-term LARS condition after surgery. Although the latest European LARS expert consensus recommends a step-up treatment strategy with gradually decreasing invasiveness, functional exercise, diet restriction, drug treatment, retrograde enema, biofeedback, and electrical stimulation only improve the symptom scores of a small number of patients, and there is no obvious improvement in most patients and their anal physiological function indicators.

[0005] Transcranial magnetic stimulation (TMS) is a non-invasive new physical therapy technique in modern rehabilitation medicine. Its principle is to use pulsed magnetic fields to act on the central nervous system (mainly the brain), change the membrane potential of cortical nerve cells, generate induced current, affect cerebral metabolism and neural electrical activities, and thus cause a series of physiological and biochemical reactions. TMS has now been widely used in neurorehabilitation therapy and is one of the most widely used non-invasive brain regulation techniques in clinical practice, such as post-stroke motor disorders, cognitive disorders, swallowing disorders, spinal cord injuries, Parkinson's disease, and depression. In recent years, magnetic stimulation technology has gradually been tried and applied successfully in the field of pelvic floor dysfunction. It does not require placing electrodes in the anus or vagina, is more effective and safe than traditional electrical stimulation methods, and has achieved good application prospects in patients with stress urinary incontinence or chronic functional constipation. This has brought new inspiration to the early rehabilitation of rectal and anal function after ISR surgery. However, there is currently a lack of precise localization of the sensory and motor cortex functional areas of the rectum and anus, especially the cortical representation of the defecation center in patients after low rectal cancer surgery has not been reported in the literature.

[0006] Functional magnetic resonance imaging (fMRI) is a new method for studying human brain function. It uses the BOLD (blood oxygen level dependent) imaging principle of neuronal metabolic activation and increased local blood flow in the corresponding cerebral cortical areas when the human body performs specific movements. It has the characteristics of non-invasiveness, high temporal and spatial resolution, can clarify the ways of higher-level neurophysiological and neuropsychological activities and the functional connections between cortices, and is expected to provide a novel and effective tool for defecation center localization. There is currently no literature reporting the cortical regulation mechanism and nuclear localization of fMRI in the defecation dysfunction after low rectal cancer surgery. For the research on LARS intervention after low rectal cancer surgery, clinical focus is currently on pelvic floor muscle rehabilitation and peripheral nerve electrical stimulation, and there is no research report on improving LARS through the localization and regulation of the higher center of the anal sphincter.

[0007] Based on this, it is expected to obtain a method and system that uses task-based functional magnetic resonance imaging technology to explore the activation state of the motor cortex of the brain during the movement of the rectum and anus muscles, find the functional nerve nuclei or pathways related to the movement of the anal sphincter, and precisely localize the cortical functional areas of the anorectal muscles, so as to seek a new treatment plan for the recovery of rectal and anal function in patients with low rectal cancer undergoing anal-preserving surgery through TMS. Summary of the Invention

[0008] In order to overcome the deficiencies of the prior art, the purpose of the present invention is to provide a method and system for localizing and regulating defecation function after ISR surgery based on fMRI.

[0009] To achieve the above object, the present invention proposes a method for regulating defecation function after ISR based on fMRI localization, and the method includes the following steps:

[0010] Step S1: Establish a localization model of fMRI anal sphincter movement;

[0011] Step S2: Through the constructed localization model of anal sphincter movement, select the activation regions related to the execution of anal sphincter movement function, and use the cerebral cortex functional area with the highest connection strength corresponding to the activation region as the regulation target;

[0012] Step S3: Perform paired stimulation on the regulation target.

[0013] Preferably, in the step S1, when establishing the localization model of fMRI anal sphincter movement, the following steps are included:

[0014] Step S11: Obtain the patient's fMRI data, and the patient's fMRI data includes task-state data and resting-state data; wherein, the fMRI data is set by using the light control method for stimulation. When the light is on, the patient relaxes the anus and is set as the resting state (i.e., abbreviated as the Rest state), and when the light is off, the patient is prompted to contract the anus as the task state (i.e., abbreviated as the Task);

[0015] Step S12: Collect and process the images to obtain a whole-brain structural image;

[0016] Step S13: Perform three-dimensional reconstruction based on the whole-brain structural image to obtain a localization model of fMRI anal sphincter movement.

[0017] Preferably, in the step S11, when setting the fMRI data by using the light control method, the scanning time for each block is 30 s, the virtual scanning time (i.e., abbreviated as Dummy scan) is 18 s, and the total scanning time is 198 s.

[0018] Preferably, in the step S12, a GE 3.0T magnetic resonance imaging device is used for image collection, and a T2-weighted gradient echo planar imaging pulse sequence sensitive to blood oxygen level changes is used for functional image collection. The parameter settings are as follows: TR = 2000 ms, TE = 35 ms, FOV = 256 mm × 256 mm, flip angle = 90°, matrix = 64 × 64, slice thickness = 4 mm, spacing = 0 mm, and 33 consecutive axial scans are performed.

[0019] Preferably, in the step S2, the activation regions include one or more of the following:

[0020] Paracentral lobule, bilateral cerebellum, left precentral gyrus, left inferior temporal gyrus, left inferior frontal gyrus, right superior frontal gyrus, right superior frontal gyrus, right inferior frontal gyrus, right central operculum, right precentral gyrus, right medial orbital gyrus, left thalamus, left globus pallidus, right putamen, left inferior parietal lobule, and right lingual gyrus.

[0021] Further preferably, the activation regions are the bilateral cerebellum and the paracentral lobule.

[0022] Preferably, in the step S3, an 8-shaped coil is used for intermittent theta-pulse transcranial magnetic stimulation during stimulation.

[0023] Preferably, the intermittent theta-pulse transcranial magnetic stimulation is specifically as follows: three pulses form a cluster, the frequency within the cluster is 50 Hz, the frequency between clusters is 5 Hz, each stimulation lasts for 2 s and is followed by an 8-s interval, there are 20 cycles, a total of 600 pulses, the intervention time for each time is 200 s, and the stimulation intensity is set to 80% of the resting motor threshold.

[0024] In a second aspect, the present invention provides a device for regulating defecation function after ISR based on fMRI localization, the device comprising:

[0025] A data acquisition unit that acquires data;

[0026] A data processing unit that establishes a localization model of fMRI anal sphincter movement based on the acquired data, and selects activation regions related to executive function through the constructed fMRI localization model, and uses the cerebral cortex functional area with the highest connection strength corresponding to the activation region as the regulation target;

[0027] An execution unit that performs paired stimulation on the regulation target.

[0028] In a third aspect, the present invention provides a system for regulating defecation function after ISR based on fMRI localization, the system comprising a processor, a memory, and a communication interface, the processor, the memory, and the communication interface are interconnected, wherein the memory is used to store a computer program, the computer program includes program instructions, and the processor is configured to call the program instructions to execute the above method.

[0029] In a fourth aspect, the present invention provides a computer-readable storage medium that stores one or more instructions, and the one or more instructions are suitable for being loaded and executed by a processor to execute the above method.

[0030] Compared with the prior art, the beneficial effects that can be achieved by at least one of the above technical solutions adopted in the embodiments of the present specification at least include:

[0031] The present invention uses task-based magnetic resonance functional imaging technology to explore the activation state of the motor cortex of the brain during the movement of the rectoanal muscles, and to find the functional nuclei or pathways related to the movement of the anal sphincter, so as to accurately locate the cortical functional area of the anorectal muscles, and thus seek a new treatment plan for the recovery of the rectoanal function of patients with low rectal tumors through TMS. Description of the Drawings

[0032] In order to more clearly illustrate the technical solutions of the embodiments of the present application, the drawings required for the embodiments will be briefly introduced below. Obviously, the drawings in the following description are only some embodiments of the present application. For those of ordinary skill in the art, without creative efforts, other drawings can also be obtained according to the drawings.

[0033] Figure 1 It is a superimposed fMRI map before and after surgery for ISR patients;

[0034] Figure 2 It is the overall flowchart of the present invention;

[0035] Figure 3 It shows the process of setting task-based fMRI using the light control method and the task state fMRI block design;

[0036] Figure 4 It shows the setting of magnetic resonance navigation marker points;

[0037] Figure 5 It shows the functional area localization and magnetic stimulation path;

[0038] Figure 6 It shows the MEP monitoring waveform diagram generated by intraoperative TMS. Detailed Embodiments

[0039] The embodiments of the present application will be described in detail below with reference to the drawings.

[0040] The following illustrates the implementation manners of the present application through specific specific examples. Those skilled in the art can easily understand other advantages and effects of the present application from the content disclosed in this specification. Obviously, the described embodiments are only a part of the embodiments of the present application, rather than all of the embodiments. The present application can also be implemented or applied through other different specific implementation manners. Various details in this specification can also be modified or changed based on different viewpoints and applications without departing from the spirit of the present application. It should be noted that, without conflict, the following embodiments and the features in the embodiments can be combined with each other. All other embodiments obtained by those of ordinary skill in the art based on the embodiments in the present application without creative efforts belong to the scope of protection of the present application.

[0041] It should be noted that the following description pertains to various aspects of embodiments within the scope of the appended claims. It will be apparent that the aspects described herein can be embodied in a wide variety of forms, and any specific structure and / or function described herein is merely illustrative. Based on this application, those skilled in the art should understand that one aspect described herein can be implemented independently of any other aspect, and two or more of these aspects can be combined in various ways. For example, any number and aspects set forth herein can be used to implement the device and / or practice the method. Additionally, this device can be implemented and this method can be practiced using other structures and / or functionality in addition to one or more of the aspects set forth herein.

[0042] Example 1: Construction of a method for regulating defecation function after ISR based on fMRI localization

[0043] In this example, the method for regulating defecation function after ISR based on fMRI localization includes the following steps:

[0044] Step S1: Establish a localization model of fMRI anal sphincter movement;

[0045] Step S2: Through the constructed localization model of anal sphincter movement, select the activation regions related to the execution of anal sphincter movement function, and use the cerebral cortex functional area with the highest connection strength corresponding to the activation region as the regulation target;

[0046] Step S3: Perform paired stimulation on the regulation target.

[0047] In some preferred embodiments, in step S1, when establishing the localization model of fMRI anal sphincter movement, the following steps are included:

[0048] Step S11: Obtain the patient's fMRI data, where the patient's fMRI data includes task-state data and resting-state data; among them, the fMRI data is set by using the light control method. When the light is on, the patient relaxes the anus and is set as the resting state, and when the light is off, the patient is prompted to contract the anus as the task state;

[0049] Step S12: Image acquisition and processing are performed to obtain a whole-brain structure image;

[0050] Step S13: Based on the whole-brain structure image, three-dimensional reconstruction is performed to obtain the localization model of fMRI anal sphincter movement.

[0051] In some other preferred embodiments, in step S11, when setting the fMRI data using the light control method, the scanning time for each block is 30 s, the virtual scanning time is 18 s, and the total scanning time is 198 s.

[0052] In some other preferred embodiments, in the step S12, a GE 3.0T magnetic resonance imaging apparatus is used for image acquisition, and a T2-weighted gradient echo planar imaging pulse sequence sensitive to blood oxygen level changes is used for functional image acquisition. The parameter settings are as follows: TR = 2000 ms, TE = 35 ms, FOV = 256 mm × 256 mm, flip angle = 90°, matrix = 64 × 64, slice thickness = 4 mm, spacing = 0 mm, and 33 consecutive axial scans are performed.

[0053] In some other preferred embodiments, in the step S2, the activation regions include one or more of the following:

[0054] Paracentral lobule, bilateral cerebellum, left precentral gyrus, left inferior temporal gyrus, left inferior frontal gyrus, right superior frontal gyrus, right superior frontal gyrus, right inferior frontal gyrus, right central operculum, right precentral gyrus, right medial orbital gyrus, left thalamus, left globus pallidus, right putamen, left inferior parietal lobule, and right lingual gyrus.

[0055] In some other preferred embodiments, in the step S3, an 8-shaped coil is used for intermittent theta-pulse transcranial magnetic stimulation during stimulation. Among them, the intermittent theta-pulse transcranial magnetic stimulation is specifically: composed of 3 pulses as a cluster, the frequency within the cluster is 50 Hz, the frequency between clusters is 5 Hz, each stimulation lasts for 2 s and is intermittent for 8 s, there are 20 cycles, a total of 600 pulses, the intervention time for each time is 200 s, and the stimulation intensity is set to 80% of the resting motor threshold.

[0056] Example 2 Device for regulating defecation function after ISR based on fMRI localization

[0057] In this embodiment, the device includes a data acquisition unit, a data processing unit, and an execution unit. Among them, the data acquisition unit acquires data; the data processing unit, based on the acquired data, establishes a localization model of fMRI anal sphincter movement, and through the constructed fMRI localization model, selects the activation regions related to the execution function, and uses the cerebral cortex functional area with the highest connection strength corresponding to the activation regions as the regulation target; and the execution unit, the execution unit performs paired stimulation on the regulation target.

[0058] Example 3 System for regulating defecation function after ISR based on fMRI localization

[0059] In this embodiment, the system includes a processor, a memory, and a communication interface. The processor, the memory, and the communication interface are interconnected. Among them, the memory is used to store a computer program, the computer program includes program instructions, and the processor is configured to call the program instructions to perform the following steps:

[0060] Step S1: Establish a localization model for fMRI anal sphincter movement;

[0061] Step S2: Through the established localization model of anal sphincter movement, select the activation regions related to the execution of anal sphincter movement function, and use the cerebral cortex functional area with the highest connection strength corresponding to the activation region as the regulation target;

[0062] Step S3: Perform paired stimulation on the regulation target.

[0063] Example 4 Computer-readable storage medium

[0064] In this example, the computer-readable storage medium stores one or more instructions, and the one or more instructions are adapted to be loaded and executed by a processor to perform the following steps:

[0065] Step S1: Establish a localization model for fMRI anal sphincter movement;

[0066] Step S2: Through the established localization model of anal sphincter movement, select the activation regions related to the execution of anal sphincter movement function, and use the cerebral cortex functional area with the highest connection strength corresponding to the activation region as the regulation target;

[0067] Step S3: Perform paired stimulation on the regulation target.

[0068] Application Example 1

[0069] In this application example, the method of Example 1 is verified. The design scheme is as follows:

[0070] Applicable objects: LARS patients after ISR for low rectal cancer.

[0071] The research content includes the following points:

[0072] 1. Locate the defecation center of the patient by fMRI before and after ISR;

[0073] 2. Detect the pelvic floor sphincter group by transcranial magnetic stimulation to verify the central target;

[0074] 3. Perform TMS stimulation treatment on the located center and evaluate the improvement effect of LARS.

[0075] Figure 1 It is the fMRI superimposed images before and after surgery for ISR patients.

[0076] As Figure 1As shown, the task-based fMRI examination of patients with low rectal cancer undergoing ISR found that activation of the paracentral lobule occurred in ISR patients both before and after surgery. Classical neuroanatomy reveals that the paracentral lobule is located on the medial surface of the cerebral hemisphere and is a continuation of the precentral gyrus and postcentral gyrus, differing from the central cortical activation representations of previous anorectal stimulation.

[0077] It can be seen from Figure 1 the feasibility of task-based fMRI in localizing the cerebral cortical functional area corresponding to anal sphincter movement. It can achieve the precise localization that previous studies on the anorectal motor functional area could not, and make up for the defect that there are no relevant large-scale research reports in existing technologies, whether it is cortical evoked potential or magnetic resonance functional imaging.

[0078] Based on the above findings, the inventor of this case further searched for the motor-related functional nuclei or pathways of the anal sphincter in the central nervous system, precisely localized the motor functional area of the anorectal muscle group, and then sought a new treatment plan for the recovery of anorectal function in patients with ultra-low rectal tumors.

[0079] Figure 2 This is the overall flowchart of the present invention.

[0080] As Figure 2 shown, the inventor of this case first discovered that the paracentral lobule of the brain region can be used as a central target for the intervention of LARS symptoms after low rectal cancer surgery, and sought a new treatment plan for the recovery of anorectal function in patients with low rectal tumors through TMS. The plan includes the following:

[0081] By selecting a cohort of patients with low rectal cancer undergoing ISR;

[0082] Selecting according to the inclusion criteria and exclusion criteria as required;

[0083] Before low rectal cancer ISR, this step uses various methods to evaluate the defecation control function of patients before and after treatment to determine whether to treat, including: fMRI, rectal function score and scale, and anorectal manometry;

[0084] Before stoma reversal, divide into two groups, one group is the TMS intervention group and the other group is the sham stimulation group.

[0085] Among them, the sham stimulation group is: when intervening, the stimulation coil is perpendicular to the head, so that the patient can hear the machine sound, but no treatment effect will be produced, and the other parameters are the same as those in the TMS group.

[0086] The TMS intervention group is: TMS intervention is carried out using the technical solution of this case. It should be noted that:

[0087] The TMS device uses MagVenture Company of Denmark. The specific operation is as follows:

[0088] 1. Measurement of motor threshold: In a quiet and comfortable environment, the patient lies semi-recumbent on the treatment bed with the body relaxed, and is instructed to keep the head fixed. The patient is wearing an EEG cap of the international 10-20 system for coil positioning. The coil position is adjusted so that the center of the front of the coil is located in the primary motor cortex (M1 area) of the dominant cerebral hemisphere. The coil plane is tangent to the stimulation site, and the resting motor threshold (RMT) is measured. The measurement method is as follows: The task-state fMRI is set using the light control method: when the light is on, the patient relaxes the anus and is set to the resting state (Rest), and when the light is off, the patient is prompted to contract the anus as the task state (Task). For details, see Figure 3 , Figure 3 which shows the process of setting the task-state fMRI using the light control method and the task-state fMRI block design. As Figure 3 shown, the virtual scan time is set to 18 s, each of the remaining blocks takes 30 s, and the total scan time for all task-state fMRI data is 198 s.

[0089] 2. fMRI navigation: The navigation platform uses the TMS Navigator platform of LOCALITE GmbH (LOCALITEGmbH, Schloss Birlinghoven, D-53757 St. Augusti, Germany) to navigate according to the cerebral cortex target points located by the patient's task-state fMRI. The specific operation steps are as follows: a. Import the patient's cranial MRI data, input the patient's basic information, and establish a personal data set; b. Set the head registration threshold and establish a three-dimensional cranial model; c. Establish a three-dimensional cranial model; d. Collect and locate the surface markers of the patient's head; e. Import the fMRI data, select the magnetic stimulation target point, the entry point, and the path; f. Real-time locate the head and the magnetic stimulation coil, and perform magnetic stimulation according to the navigation data.

[0090] 3. Transcranial magnetic stimulation intervention: The magnetic stimulator device is the MagPro X100 magnetic stimulator produced by MagVenture A / S (Lucernemarken, DK-3520 Farum, Denmark), which is adapted to the figure-eight coil MCF-P-B70 transcranial magnetic stimulator. The maximum stimulation frequency is 30 Hz, and the maximum stimulation intensity is 6.0 T.

[0091] 4. Perform intermittent theta-burst transcranial magnetic stimulation (iTBS) protocol stimulation: Each cluster consists of 3 pulses, the frequency within the cluster is 50 Hz, the frequency between clusters is 5 Hz, with an 8-s interval for every 2-s stimulation, for 20 cycles, a total of 600 pulses, and each intervention time is 200 s. The stimulation intensity is set to 80% of the resting motor threshold. The intervention is performed once a day, 5 days a week, for a total of 2 weeks.

[0092] It should be noted that during fMRI navigation, image acquisition is performed using a GE 3.0T magnetic resonance imaging scanner, and the subject's head is strictly immobilized. For functional image acquisition, a T2-weighted gradient echo planar imaging pulse sequence (EPI) sensitive to blood oxygenation level changes is used. The parameter settings are as follows: TR = 2000 ms, TE = 35 ms, FOV = 256 mm × 256 mm, flip angle = 90°, matrix = 64 × 64, slice thickness = 4 mm, slice gap = 0 mm. 33 consecutive axial scans are performed to cover the whole brain.

[0093] To facilitate three-dimensional reconstruction and spatial normalization, 3D whole-brain structural images are acquired using the MPRAGE sequence, and its parameter design is as follows: TR = 2300 ms, slice thickness 1.0 mm, flip angle = 90°, matrix 256 × 256, NEX 1.0, FOV = 256 mm × 256 mm, slice thickness = 1.0 mm, slice gap = 0 mm, and three-dimensional scanning of the whole brain is performed.

[0094] The acquired images are processed and the data are analyzed. Among them, functional data are processed using the SPM12 analysis software (https: / / www.fil.ion.ucl.ac.uk / spm / ).

[0095] The results show that there are individual differences in the cortical localization of the anal sphincter group in ISR patients before and after surgery. The activated regions are commonly found in the paracentral lobule, bilateral cerebellum, left precentral gyrus, left inferior temporal gyrus, left inferior frontal gyrus (opercular part), right superior frontal gyrus, right superior frontal gyrus, right inferior frontal gyrus (orbital part), right central operculum, right precentral gyrus, right medial orbital gyrus, left thalamus, left globus pallidus, right putamen, left inferior parietal lobule, right lingual gyrus, etc. More than 1 / 2 of the patients will have activation of the bilateral cerebellum and paracentral lobule at the same time, and all patients have activation of the paracentral lobule.

[0096] According to the paracentral lobule in the specific cortical activation region mined by the above task-based fMRI, the corresponding ISR prophylactic stoma reversal patients are selected as verification cases. Using the paracentral lobule in the cortical localization area before and after ISR surgery as the TMS stimulation target area, intraoperative anal sphincter electromyogram monitoring is performed after successful anesthesia (in the state of muscle relaxation antagonism). iTBS stimulation indicates obvious sphincter contraction, indicating accurate localization of the specific cortical target area (for this result, see Figure 6 ). The clinical follow-up data of 20 ISR patients suggest that TMS can significantly improve the anal function after ISR stoma reversal. The symptoms of patients such as defecation difficulty, tenesmus, antidiarrheal drug dependence, and frequent defecation are significantly improved, and there is no nocturnal incontinence.

[0097] Figure 4 For the setting of magnetic resonance navigation marker points.

[0098] Such as Figure 4As shown, surface markers of the patient's head are collected and located, including three positions: the nasion, and in front of the left and right tragus. This can be used to plan the installation points of the coil on the head and the stimulation targets.

[0099] Figure 5 It shows the functional area localization and the magnetic stimulation path.

[0100] As Figure 5 shown, after importing the DICOM format data of fMRI according to the patient's three-dimensional cranial model, the activated area is selected as the target point (Target), and the system will automatically calculate the entry point (Entry), and place the magnetic stimulation coil according to the path.

[0101] Figure 6 It is the MEP monitoring waveform diagram generated by intraoperative TMS. It should be noted that Figure 6 the text in Figure 6 schematically shows the operation interface, and it can be seen from

[0102] that through clinical testing by stimulating the target area during intraoperative TMS and monitoring the activity status of the anal sphincter by electromyogram, it is found that obvious MEP potentials can be generated in the anal sphincter during TMS, verifying that this cortical area can be used as an effective target area for TMS stimulation.

[0102] In addition, according to the clinical follow-up data of a small sample (10 cases in the TMS group and 10 cases in the control group) (see Table 1), TMS can significantly improve the anal function after ISR stoma reversal (LARS score at 1 month after surgery: TMS group vs control group, 30.70±3.13 vs 34.60±4.43, P = 0.04; LARS score at 3 months after surgery: TMS group vs control group, 27.30±3.09 vs 30.10±2.03, P = 0.03). Symptoms such as defecation difficulty, tenesmus, dependence on antidiarrheal drugs, and frequent defecation of the patients have improved significantly, and there is no nocturnal incontinence.

[0103] Table 1. Changes in LARS scores of patients after ISR stoma reversal (mean ± standard deviation)

[0104]

[0105] P* in Table 1 represents the P value.

[0106] The above embodiments are only for illustrating the technical concept and features of the present invention, and the purpose is to enable those of ordinary skill in the art to understand the content of the present invention and implement it accordingly. It cannot be used to limit the protection scope of the present invention. Any equivalent changes or modifications made according to the essence of the content of the present invention should be covered within the protection scope of the present invention.

Claims

1. A method for regulating defecation function after ISR surgery based on fMRI positioning, characterized in that: The method comprises the following steps: Step S1: Establishing the localization model of fMRI anal sphincter movement; Step S2: selecting the activation area related to the execution of the anal sphincter movement function through the constructed positioning model of the anal sphincter movement, and the cerebral cortical functional area with the highest connection strength corresponding to the activation area is used as the regulation target; Step S3: Stimulate the regulatory targets in pairs.

2. The method according to claim 1, characterized in that In step S1, establishing the fMRI anal sphincter movement positioning model includes the following steps: Step S11: Acquire patient fMRI data, wherein the patient fMRI data includes task state data and resting state data; wherein, light control method is used to stimulate to set fMRI data, when the light is turned on, the patient relaxes the anus to set it to the resting state, and when the light is turned off, the patient is prompted to contract the anus to set it to the task state; Step S12: collecting and processing images to obtain a whole-brain structural image; Step S13: Perform three-dimensional reconstruction based on the whole brain structural image to obtain the fMRI positioning model of anal sphincter movement.

3. The method according to claim 2, characterized in that In step S11, when the fMRI data is set by the light control method, the scanning time of each block is 30 seconds, the virtual scanning time is 18 seconds, and the total scanning time is 198 seconds.

4. The method according to claim 2, characterized in that: In step S12, a GE 3.0T magnetic resonance imager is used for image acquisition, and a T2-weighted gradient echo planar imaging pulse sequence that is sensitive to changes in blood oxygen levels is used for functional image acquisition. The parameters are set as follows: TR=2000ms, TE=35ms, FOV=256mm×256mm, flip angle=90°, matrix=64×64, layer thickness=4mm, spacing=0mm, and 33 layers of continuous axial scanning.

5. The method according to any one of claims 1 to 4, characterized in that: In step S2, the activation area includes one or more of the following: paracentral lobule, bilateral cerebellum, left precentral gyrus, left inferior temporal gyrus, left inferior frontal gyrus, right superior frontal gyrus, right inferior frontal gyrus, right operculum, right precentral gyrus, right medial orbital gyrus, left thalamus, left globus pallidus, right putamen, left inferior parietal lobule, and right lingual gyrus.

6. The method according to any one of claims 1 to 4, characterized in that: In step S3, an 8-shaped coil is used to perform intermittent theta pulse transcranial magnetic stimulation.

7. The method according to claim 6, characterized in that The intermittent theta pulse transcranial magnetic stimulation is specifically: a cluster consists of 3 pulses, the frequency within the cluster is 50 Hz, the frequency between clusters is 5 Hz, each stimulation is 2 seconds and the interval is 8 seconds, 20 cycles, a total of 600 pulses, each intervention time is 200 seconds, and the stimulation intensity is set to 80% of the resting motor threshold.

8. A device for regulating defecation function after ISR surgery based on fMRI positioning, characterized in that: The device comprises: A data acquisition unit, wherein the data acquisition unit acquires data; A data processing unit, wherein the data processing unit establishes an fMRI anal sphincter movement positioning model based on the collected data, and selects an activation area related to executive function through the constructed fMRI positioning model, wherein the cerebral cortex functional area with the highest connection strength corresponding to the activation area is used as a control target; An execution unit is used to perform paired stimulation on the regulation targets.

9. A system for regulating defecation function after ISR surgery based on fMRI positioning, characterized in that: The system includes a processor, a memory and a communication interface, wherein the processor, the memory and the communication interface are interconnected, wherein the memory is used to store a computer program, the computer program includes program instructions, and the processor is configured to call the program instructions to execute the method according to any one of claims 1 to 7.

10. A computer-readable storage medium, characterized in that: The computer-readable storage medium stores one or more instructions, and the one or more instructions are suitable for being loaded by a processor and executing the method according to any one of claims 1 to 7.

Images