基于Logistic回归分析217例复杂性肛瘘患者术后肛门功能障碍的中西医危险因素研究

Risk factors of postoperative anal dysfunction in 217 patients with complex anal fistula treated by Chinese medicine and western medicine based on Logistic regression analysis

目的 探讨复杂性肛瘘术后并发肛门功能障碍的中西医危险因素。方法 回顾性分析2020年7月至2022年1月福建中医药大学附属人民医院肛肠科收治的217例复杂性肛瘘患者的临床资料。根据是否出现术后肛门功能障碍将患者分为功能障碍组(47例)及功能正常组(170例)。结合患者围手术期情况、手术方式选择、中医诊疗因素3方面变量进行单因素分析及多因素Logistic回归分析。结果 术后并发肛门功能障碍的发生率为21.66%,严重程度以轻度为主[美国克利夫兰医学中心肛门失禁评分(Cleveland Clinic Florida Fecal incontinence score, CCFIS)为(3.72±0.949)分]。多因素Logistic回归分析结果显示:括约肌上瘘(OR=6.036,95%CI 1.809~20.140,P=0.003)、有1次以上的既往手术史(OR=15.597,95%CI 3.371~72.439,P=0.000)、手术方式为切割挂线术(OR=1.435,95%CI 1.088~1.894,P=0.011)、中医证候为气血两虚型(OR=2.762,95%CI 1.002~7.613,P=0.049)或正虚邪恋型(OR=5.339,95%CI 1.277~12.318,P=0.022)5个因素为复杂性肛瘘术后并发肛门功能障碍的独立危险因素(P<0.05);静息压值(OR=0.107,95%CI 0.033~0.345,P=0.000)、术后有中药干预治疗(OR=0.311,95%CI 0.122~0.790,P=0.014)与术后肛门功能障碍呈负相关(P<0.05,OR<1),为术后肛门功能的保护性因素。结论 复杂性肛瘘术后并发肛门功能障碍的西医危险因素为括约肌上瘘、有1次以上既往手术史、手术方式为切割挂线术、低静息压;中医危险因素为气血两虚型或正虚邪恋型肛瘘、术后无中药干预;实现术后风险因素的早期识别,可为临床复杂性肛瘘个体化治疗方案的选择提供良好的参考依据。

Objective To explore the risk factors of anal dysfunction after complex anal fistula surgery treated by Chinese medicine and western medicine. Methods The clinical data of 217 patients with complex anal fistula admitted to the Anorectal Department of The People’s Hospital of Fujian University of Chinese Medicine from July 2020 to January 2022 were analyzed retrospectively. The patients were divided into dysfunction group(n =47) and normal function group(n =170) according to the postoperative condition. Univariate analysis and multifa ctor Logistic regression analysis were conducted based on the patient’s perioperative conditions, operation methods, and factors affecting TCM diagnosis and treatment. Results The incidence of postoperative anal dysfunction was 21.66%, with mild symptoms [Cleveland Clinic Florida Fecal incontinence score(CCFIS)=(3.72±0.949)]. The results of multifactor Logistic regression analysis showed that: fistula type of supra-sphincter fistula(OR=6.036, 95%CI1.809~20.140, P=0.003), perianal abscess or fistula surgery with more than once in the past(OR=15.597, 95%CI 3.371~72.439, P=0.000), thread-drawing method(OR=1.435, 95%CI 1.088~1.894, P=0.011), qi-blood deficiency(OR=2.762, 95%CI 1.002~7.613, P=0.049)and pattern of healthy qi deficiency and pathogenic qi attacking(OR=5.339, 95%CI 1.277~12.318, P=0.022), were independent risk factors for postoperative anal dysfunction(P<0.05);the resting pressure(OR=0.107, 95%CI 0.033~0.345, P=0.000) and the intervention of Chinese medicine after operation(OR=0.311, 95%CI 0.122~0.790, P =0.014) were negatively correlated with postoperative anal dysfunction(P<0.05, OR<1), which were protective factors for postoperative anal function. Conclusion The risk factors of western medicine include fistula type of supra-sphincter fistula, perianal abscess, fistula surgery with more than once in the past, threaddrawing method, and low resting pressure. The risk factors of Chinese medicine include qi-blood deficiency, pattern of healthy qi deficiency and pathogenic qi attacking, and no application of TCM after surgery. Early identification of risk factors of postoperative anal dysfunction can be referred for the individualized treatment plan for clinical complex anal fistula.