经括约肌型肛瘘患者肛瘘栓填塞治疗预后的影响因素分析

Factors influencing the prognosis of patients with transsphincter anal fistula treated with anal fistula plug

目的探讨经括约肌型肛瘘患者肛瘘栓填塞治疗预后的影响因素。方法回顾性分析2017年9月至2019年9月海南西部中心医院收治的110例经括约肌型肛瘘患者临床资料,所有患者均采用肛瘘栓填塞治疗,按照随访预后情况将其分为预后良好组(n=78)和预后不良组(n=32),比较两组患者性别、年龄、病程、肛瘘外口距肛缘距离、手术时间、BMI、手术创面面积、术后感染、既往肛门手术史、合并糖尿病、瘘管数目等指标差异,并采用多因素Logistic回归分析探讨经括约肌型肛瘘患者肛瘘栓填塞治疗预后的影响因素。结果预后不良组年龄>40岁、既往有肛门手术史、合并糖尿病患者比例高于预后良好组,病程、肛瘘外口距肛缘距离长于预后良好组,手术创面面积大于预后良好组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示年龄>40岁、病程较长、肛瘘外口距肛缘距离较长、手术创面面积较大、既往有肛门手术史、合并糖尿病是经括约肌型肛瘘患者预后不良的危险因素。结论肛瘘栓填塞治疗经括约肌型肛瘘患者的预后受多种因素影响,需临床医师关注以改善预后。

Objectives To investigate factors influencing the prognosis of patients with transsphincter anal fistula treated with anal fistula plug.Methods This was a retrospective analysis of 110 patients with transsphincter anal fistula treated at the Hainan Western Central Hospital between September 2017 and September 2019.All patients received anal fistula plug and were divided into good-prognosis group(n=78)and poor-prognosis group(n=32).Potential risk factors included sex,age,disease duration,the distance between external fistula orifice and anal verge,body mass index,duration of surgery,surgical wound area,postoperative wound infection,history of anal surgery,diabetes,and the number of fistula tracts were compared beween groups.Multivariate Logistic regression analyses were performed to investigate independent risk factors influencing patients’prognosis.Results Compared with patients in the good-prognosis group,patients in the poor-prognosis group were significantly more likely to be>40 years old and to have a history of anal surgery and diabetes(P<0.05).Disease duration and the distance between external fistula orifice and anal verge were significantly longer,and the surgical wound area was significantly larger in the poor-prognosis group(P<0.05).Multivariate Logistic regression analyses showed that>40 years old,longer disease duration,longer distance between external fistula orifice and anal verge,larger surgical wound area,history of anal surgery,and diabetes were independent risk factors influencing the prognosis of patients with transsphincter anal fistula treated with anal fistula plug.Conclusion Prognostic factors for patients with transsphincter anal fistula treated with anal fistula plug are multifactorial.Physicians should be aware of these potential factors in order to improve patients’prognosis.