复杂性肛瘘挂线术后肛门功能评估的前瞻性队列分析研究

Prospective Cohort Study on Evaluation of Anal Function after Cutting Seton of Complex Anal Fistula

目的:通过前瞻性队列研究,观察中医切割挂线术治疗复杂性肛瘘的术后肛门功能失调及复发情况,探讨中医切割挂线术的优劣。方法:筛选符合纳入标准的患者119例,采用前瞻性队列研究方法,以患者是否行切割挂线作为暴露因素,以瘘管复发做为研究终点,分为暴露组和非暴露组,观察术后3个月两组复发情况,及克利夫兰肛门失禁评分、肛门直肠压力测定指标(肛管静息压、肛管最大收缩压、肛管括约肌功能长度、直肠初始感觉容量、最大耐受容量)等情况,并对其进行分析。结果:暴露组75例,复发5例,复发率6.67%;非暴露组44例,复发10例,复发率22.7%。经卡方检验,χ^(2)=6.493,RR 0.243,95%CI(0.077,0.766),P=0.011<0.05。两组术后3个月克利夫兰医学中心(Cleveland Clinic Foundation,CCF)肛门失禁评分、肛管静息压、肛管括约肌功能长度、最大耐受容量等肛门直肠动力学指标存在统计学差异(P<0.05)。肛管最大收缩压,直肠初始感觉容量两组对比差异无统计学差异。结论:中医切割挂线疗法治疗复杂性肛瘘疗效确切,复发率低,且应用原理简单,易于推广;但因其对括约肌损伤,术后可能出现不同程度的控便功能失调的问题,因此操作过程需结合临床实际,注意细节把握,不断优化术式,使该术式的临床应用惠及更多患者。

Objective:Through prospective cohort study,observe the postoperative anal dysfunction and recurrence of complicated anal fistula treated by traditional Chinese medicine cutting and threading,and to explore the advantages and disadvantages of traditional Chinese medicine cutting and threading.Methods:119 patients who met the inclusion criteria were screened.A prospective cohort study method was used.Whether the patients were cut and threaded as the exposure factor and the fistula recurrence as the research end point,they were divided into exposure group and non-exposure group,and 3 groups were observed after operation.Recurrence in the two groups at the first month,as well as Cleveland anal incontinence score,anorectal pressure measurement indicators (anal resting pressure,anal maximum systolic pressure,anal sphincter functional length,rectal initial sensory capacity,maximum tolerable capacity),etc.,And analyze it.Results:There were 75 cases in the exposed group,5 cases of recurrence,and the recurrence rate was 6.67%;44 cases in the non-exposure group,10 cases of recurrence,and the recurrence rate was 22.7%.After chi-square test,χ^(2)=6.493,RR 0.243,95%CI (0.077,0.766),P=0.011<0.05.Three months after surgery,the Cleveland Clinic Foundation (CCF) anal incontinence score,anal resting pressure,anal sphincter function length,maximum tolerable capacity and other anorectal dynamics were statistically different between the two groups (P< 0.05).The maximum systolic pressure of the anal canal and the initial sensory volume of the rectum were not significantly different between the two groups.Conclusion:Traditional Chinese medicine cutting and thread-drawing therapy is effective in treating complicated anal fistula,with low recurrence rate,simple application principle,and easy promotion.However,due to its damage to the sphincter,there may be varying degrees of fecal control dysfunction after surgery,so the operation process It is necessary to combine clinical practice,pay attention to details,and continuously optimize the surgical method,so that the clinical application of the surgical method can benefit more patients.