肛瘘经括约肌间瘘管结扎后肛门功能恢复的相关影响因素分析

Analysis of related influencing factors on anal function recovery after ligation of anal fistula through sphincter

目的探讨肛瘘经括约肌间瘘管结扎后肛门功能的恢复情况及其影响因素。方法采取病例对照研究方法,选取海口市中医医院2019年1月—2022年8月收治的172例肛瘘患者作为研究对象。统计分析患者手术前后肛门功能恢复情况,根据患者术后3个月的肛门功能恢复情况将其分为良好组140例、不良组32例。比较两组患者的手术指标、术后并发症及基线资料,采用多因素一般Logistic回归分析影响手术后肛门功能恢复的相关因素。结果良好组手术后创面愈合更早(P<0.05),疼痛持续时间更短(P<0.05),总体平均住院总时间短于不良组(P<0.05)。良好组与不良组术后1、2、3个月的Wexner量表评分比较,采用重复测量设计的方差分析,结果:①不同时间点的Wexner量表评分有差异(P<0.05);②两组的Wexner量表评分有差别(P<0.05),良好组Wexner量表评分较不良组低,肛门功能恢复较好。③两组的Wexner量表评分变化趋势有差异(P<0.05)。良好组患者的病程、瘘管长度、Parks分型、术后切口感染率、二次手术率(再次实施清创手术)、治疗依从性(术后用药是否遵从医嘱)、术后机械性刺激率(术后各种外因刺激肛门)与不良组比较,差异均有统计学意义(P<0.05)。多因素一般Logistic回归分析结果显示,肛瘘患者病程[OR=1.842(95%CI:1.105,3.073)]、瘘管长度[OR=1.788(95%CI:1.137,2.812)]、术后切口感染[OR=1.694(95%CI:1.081,2.653)]、再次手术[OR=1.347(95%CI:1.018,1.783)]、治疗依从性[OR=1.493(95%CI:1.058,2.108)]是肛瘘患者括约肌间瘘管结扎后肛门功能恢复不良的影响因素(P<0.05)。结论肛瘘患者经括约肌间瘘管结扎后肛门功能大部分恢复良好,但是肛瘘患者病程较长、瘘管长度较长、出现术后切口感染、术后再次手术、治疗依从性差可能会增大患者术后肛门功能恢复不良的风险。

Objective To investigate the recovery of anal function and its influencing factors after ligation of anal fistula through sphincter fistula.Methods In this study,a case-control study was adopted.172 patients with anal fistula admitted to Haikou Hospital of Traditional Chinese Medicine from January 2019 to August 2022 were selected as the study objects.The anal function recovery of patients before and after surgery was statistically analyzed.According to the anal function recovery of patients 3 months after surgery,they were divided into 140 patients with good anal function(good group)and 32 patients with poor anal function(bad group).The operation process indicators,postoperative complications Based on the baseline data,the logistic regression model was used to analyze the related factors affecting the anal function recovery after surgery.Results The patients in the good group healed earlier after surgery(P<0.05),the pain duration of patients was shorter(P<0.05),and the overall average total hospitalization time of patients was shorter than that of patients in the bad group(P<0.05),and the difference was statistically significant(P<0.05).The Wexner scale scores of the good group and the bad group were compared one month,two months and three months after the operation,and the analysis of variance of the repeated measurement design was used.The results showed that the Wexner scale scores of the two groups at different time points were different(P<0.05),the Wexner scale scores of the good group and the bad group were different(P<0.05),and the Wexner scale scores of the good group were lower than those of the bad group.The anal function recovered well and the difference was statistically significant(P<0.05).The change trend of Wexner scale score between the good group and the bad group was different(P<0.05),and the difference was statistically significant(P<0.05).The course of disease(P<0.05),fistula length(P<0.05)and Parks classification of patients in the good group(P<0.05).Postoperative incision infection rate(P<0.05),secondary operation rate(debridement operation again)(P<0.05),treatment compliance(whether the postoperative medication complies with the doctor's order)(P<0.05),postoperative mechanical stimulation rate(various external causes stimulate anus after operation)(P<0.05)compared with the adverse group,the difference was statistically significant(P<0.05).The results of logistic regression model showed a longer course of disease[OR=1.842(95%CI:1.105,3.073)],a longer fistula length[OR=1.788(95%CI:1.137,2.812)],postoperative incision infection[OR=1.694(95%CI:1.081,2.653)],postoperative reoperation[OR=1.347(95%CI:1.018,1.783)],poor treatment compliance[OR=1.493(95%CI:1.058,2.108)]were the risk factors of poor recovery of anal function in patients with anal fistula after ligation of sphincter fistula(P<0.05).Conclusion Most of the anal function of anal fistula patients recovered well after ligation of fistula between sphincters,but the risk of poor anal function recovery may be increased due to long course of disease,long fistula length,postoperative incision infection,reoperation,and poor treatment compliance of anal fistula patients.