不同术式治疗肛周脓肿后肛瘘形成的影响因素分析

Analysis of influencing factors of anal fistula formation after perianal abscess operation with different operation methods

目的:探讨肛周脓肿行不同手术方式治疗后肛瘘的形成及其影响因素。方法:回顾性分析2019年1月—2020年1月西安市中医医院肛肠科收治的298例行肛周脓肿手术治疗患者的临床资料,通过单因素和多因素Logistic回归分析肛周脓肿手术治疗后肛瘘形成的影响因素。结果:经过1年的随访,肛周脓肿手术治疗后肛瘘形成的发生率为11.7%(35/298),根治组肛瘘发生率明显低于引流组(3.6%vs 26.4%,P<0.05)。单因素分析发现,既往肛周手术史、入院前是否发热、入院前是否使用抗生素、入院前病程、脓肿部位、脓肿范围、入院前脓肿是否破溃、手术方式、脓液细菌培养结果、白细胞数、中性粒细胞比率、纤维蛋白原、D-二聚体及住院天数是肛周脓肿术后肛瘘形成的影响因素(P<0.05)。多因素Logistic回归分析发现,既往有肛周手术史(OR=2.404,95%CI:1.047~5.522,P=0.039)、入院前使用抗生素(OR=2.381,95%CI:1.090~5.204,P=0.030)是肛周脓肿术后肛瘘形成的危险因素,一期根治术手术方式是保护因素(OR=0.125,95%CI:0.052~0.304,P<0.01)。结论:既往有肛周手术史、入院前使用抗生素的患者肛周脓肿术后更易形成肛瘘;而一期根治术较切开引流术有较低的术后肛瘘发生率。

Objective To investigate the influencing factors of anal fistula formation after perianal abscess surgical treatment with different operation methods.Methods A retrospective study was conducted between January 2019 and January 2020.Clinical data of 298 patients with perianal abscess from the department of Anorectal of Xi’an Hospital of Traditional Chinese Medicine were collected.Univariate and multivariate Logistic regression were used to analyze the related factors of the formation of anal fistula between different surgical methods.Results After 1 year follow-up,the incidence of anal fistula after surgical treatment of perianal abscess was 11.7%(35/298).The incidence of anal fistula in the radical treatment group was significantly lower than that in the drainage group(3.6%vs 26.4%,P<0.05).Univariate analysis found that the history of anal operation,fever,whether to use antibiotics prior to admission,course of disease before admission,abscesses location,scope of abscess,the pre-hospital burst,operation method,pus germiculture results,white blood cell count,neutrophils ratio,fibrinogen,D-dimer,hospitalization days were related to postoperative anal fistula formation.(P<0.05).Multivariate Logistic regression analysis showed that previous perianal surgery(OR=2.404,95%CI:1.047-5.522,P=0.039),use of antibiotics before admission(OR=2.381,95%CI:1.090-5.204,P=0.030)was a risk factor of anal fistula after perianal abscess surgery,and surgical method(Primary radical resection)was a protective factor(OR=0.125,95%CI:0.052-0.304,P<0.01).Conclusion The patients with a history of perianal surgery and antibiotics before admission were more likely to form anal fistula after perianal abscess.Primary radical resection had lower incidence of postoperative anal fistula than drainage.