改良经肛括约肌间切开术治疗高位肛瘘患者的疗效及对肛门功能的影响OA
Efficacy of Modified Transanal Opening of the Intersphincteric Space in Treatment of Patients with High Anal Fistula and Its Effect on Anal Function
目的:分析改良经肛括约肌间切开术(TROPIS)治疗高位肛瘘患者的疗效及对肛门功能的影响.方法:采用随机数字表法将2020年8月至2023年7月我科收治的128例高位肛瘘患者分入两组,一组接受传统切开挂线术治疗(对照组,64例),另一组接受改良TROPIS治疗(观察组,64例).比较2组总有效率、围手术期指标、术后并发症发生率及术后肛门功能.进一步根据术后1年肛门功能情况将128例患者分为肛门功能下降组和未下降组,采用多因素Logistic回归分析高位肛瘘患者术后肛门功能下降的影响因素.结果:观察组总有效率(96.88%,62/64)高于对照组(85.94%,55/64),P<0.05.观察组术中出血量、瘢痕面积小于对照组,手术时间、住院时间、创面愈合时间均短于对照组,P<0.05.观察组术后并发症发生率(12.50%,8/64)低于对照组(29.69%,19/64),P<0.05.观察组术后Wexner肛门失禁评分低于对照组,P<0.05.肛门功能下降组患者体质量指数(BMI)、多瘘管患者占比、内口不明确患者占比、传统切开挂线术占比均高于未下降组,P<0.05.多因素分析显示,BMI高(OR=1.848,95%CI:1.369～2.494)、内口不明确(OR=2.472,95%CI:1.667～3.665)、传统切开挂线术(OR=3.013,95%CI:1.901～4.776)是高位肛瘘患者术后肛门功能下降的危险因素,P<0.05.结论:改良TROPIS治疗高位肛瘘疗效显著,可改善围术期指标,降低并发症发生率,并减轻术后肛门功能损伤.BMI≥24 kg/m2、内口不明确及传统切开挂线术是高位肛瘘患者术后肛门功能下降的危险因素.
Objective To analyze the efficacy of modified transanal opening of the intersphincteric space(TROPIS)in the treatment of patients with high anal fistula and its effect on anal function.Methods A total of 128 patients with high anal fistula admitted to our department from August 2020 to July 2023 were divided into two groups using a random number table method.One group received traditional incision and thread-drawing therapy(the control group,64 cases),and the other group was treated with modified TROPIS(the observation group,64 cases).The total effective rate,perioperative indicators,incidence of postoperative complications,and postoperative anal function were compared between the two groups.Furthermore,accord-ing to the anal function status 1 year after surgery,the 128 patients were divided into an anal function-decline group and a non-decline group.Multivariate Logistic regression analysis was used to identify the influencing fac-tors of postoperative anal function decline in patients with high anal fistula.Results The total effective rate of the observation group was 96.88%(62/64),which was significantly higher than that of the control group(85.94%,55/64),with a statistically significant difference(P<0.05).The intraoperative blood loss and scar area in the observation group were smaller than those in the control group,and the operation time,hospital stay,and wound healing time were all shorter than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was 12.50%(8/64),which was lower than 29.69%(19/64)in the control group(P<0.05).The postoperative Wexner fecal incontinence score of the observation group was lower than that of the control group(P<0.05).The body mass index(BMI),proportion of patients with multiple fistulas,proportion of patients with unclear internal orifices,and proportion of patients receiving tradi-tional incision and thread-drawing therapy in the anal function-decline group were all higher than those in the non-decline group(P<0.05).Multivariate analysis showed that high BMI(OR=1.848,95%CI:1.369−2.494),unclear internal orifices(OR=2.472,95%CI:1.667−3.665),and traditional incision and thread-drawing therapy(OR=3.013,95%CI:1.901−4.776)were independent risk factors for postoperative anal function decline in patients with high anal fistula(P<0.05).Conclusion Modified TROPIS has a signifi-cant efficacy in the treatment of high anal fistula,which can improve perioperative indicators,reduce the inci-dence of complications,and alleviate postoperative anal function injury.BMI≥24 kg/m²,unclear internal ori-fices,and traditional incision and thread-drawing therapy are risk factors for postoperative anal function decline in patients with high anal fistula.
雷成方;鲁恩军;何晓艳
武汉大学中南医院嘉鱼医院肛肠科(湖北 咸宁 437200)武汉大学中南医院嘉鱼医院肛肠科(湖北 咸宁 437200)武汉大学中南医院嘉鱼医院肛肠科(湖北 咸宁 437200)
高位肛瘘改良TROPIS疗效肛门功能
High anal fistulaModified TROPISEfficacyAnal function
《中国肛肠病杂志》 2026 (2)
27-31,5
评论