复杂性肛瘘患者复发影响因素分析

Factors associated with recurrence of complex fistula-in-ano

目的探讨复杂性肛瘘复发的相关影响因素。方法回顾性分析上海曙光医院东院肛肠科2013年1月至2017年6月收治并行手术治疗的2 841例复杂性肛瘘患者临床资料,探讨临床参数与肛瘘复发之间的关系。结果在2 841例手术患者中,有47例患者出现复发,总复发率为1.7%。单因素分析结果显示,男性患者复发率比女性患者高,有吸烟史患者复发率比无吸烟史患者高,有肛瘘手术史患者复发率比无肛瘘手术史患者高,挂线患者复发率比未挂线患者高,高位复杂性肛瘘复发率比低位复杂性肛瘘患者高,且年龄与复发有关(均P <0.05)。内外口方位、有无糖尿病史和有无肠炎史与复发无关,差异均无统计学意义(均P> 0.05)。多因素Logitstic分析结果显示,既往有肛瘘手术史与高位肛瘘是复杂性肛瘘术后复发的独立危险因素(OR分别为5.895、2.748,95%CI分别为2.977~11.477、1.299~5.814)。结论既往有肛瘘手术史或高位肛瘘的复杂性肛瘘患者术后复发率较高,在临床上对于此类患者更需要重视,以提高临床治愈率。

Objectives To investigate factors associated with recurrence of complex fistula-in-ano. Methods A retrospective analysis of 2 841 patients with complex fistula-in-ano treated in the Department of Anorectal Diseases, Eastern Hospital of Shuguang Hospital, between January 2013 and June 2017 was performed. The relationship between clinical parameters and the recurrence was analyzed. Results Of the 2 841 patients, 47 had recurrence, with a total recurrence rate of 1.7%. Univariate analysis showed that recurrence rate was higher in men than in women, in patients with smoking history than in those without, in those who received surgery for fistula-in-ano than in those did not, in those who received seton than those did not, in high than in low fistula-in-ano, and the recurrence was associated with age(P < 0.05). Multivariate logistic regression showed that history of surgery for fistula-in-ano(OR: 5.895, 95%CI: 2.977~11.477) and high fistula-in-ano(OR: 2.748, 95%CI: 1.299-5.814) were independent risk factors for recurrence. Conclusion Patients with history of surgery for fistula-in-ano and high fistula-in-ano had higher risk of recurrence. Cautions should be exercised when treating these patients with complex fistula-in-ano.