经括约肌间入路的联合虚实结合挂线法治疗后位高位复杂性肛瘘的疗效及复发因素分析

Long-term efficacy of intersphincter approach combined with virtual solid and hanging line in the treatment of posterior high complex anal fistulas and risk factors for recurrence

目的探讨经括约肌间入路联合虚实结合挂线法治疗后位高位复杂性肛瘘的疗效及复发因素。方法回顾性纳入2020年4月至2023年6月期间于笔者所在医院就诊的167例后位高位复杂性肛瘘患者,根据治疗方法不同,将患者分为2组,即采用经括约肌间入路的联合虚实结合挂线法治疗组(简称观察组,n=88)和切割挂线引流术治疗组(简称对照组,n=79)。比较2组患者的一般临床资料,以及术前和术后1、2和3个月瘘道内口高度和肛管直肠压力。根据随访期间复发情况分为复发组(n=50)和未复发组(n=117),采用单因素和多因素logistic回归分析术后肛瘘复发的危险因素,采用Kaplan-Meier法绘制无复发曲线。结果与对照组患者相比:观察组患者的手术时间更长、创面愈合时间及住院时间更短,差异有统计学意义(P<0.05);观察组术后1、2、3个月的肛门静息压和肛门最大缩榨压较高,内口高度较低,差异具有统计学意义(P<0.05)。复发组与未复发组患者在年龄、体质量指数、性别、出院后定期至医院换药、肛瘘手术史、内口明确及治疗方式方面比较差异具有统计学意义(P<0.05);多因素logistic回归分析结果显示,出院后未定期至医院换药、有肛瘘手术史、内口不明确及切割挂线引流术是后位高位复杂性肛瘘患者术后复发的危险因素(P<0.05)。观察组和对照组患者术后累积未复发率分别为84.58%和67.73%,其差异有统计学意义(P<0.05)。结论经括约肌间入路联合虚实结合挂线法治疗后位高位复杂性肛瘘在肛门功能保护和促进创面愈合方面具有较好的效果;出院后未定期到医院换药、有肛瘘手术史、内口不明确及切割挂线引流术是后位高位复杂性肛瘘患者术后复发的影响因素,应引起重视。

Objective To investigate the long-term efficacy of intersphincter approach combined with virtual solid and hanging line in the treatment of posterior high complex anal fistulas and risk factors for recurrence.Methods A total of 167 patients with posterior high complex anal fistula treated in our hospital from April 2020 to June 2023 were retrospectively included.According to different treatment methods,the patients were divided into observation group(n=88)and control group(n=79).The observation group was treated with the combination of virtual solid and hanging line via intersphincter approach,while the control group was treated with cutting and wire hanging drainage.The general clinical data,the height of the internal fistula opening and the anorectal pressure before and after 1,2 and 3 months were compared between the two groups.The patients were divided into recurrence group(n=50)and non-recurrence group(n=117)according to the recurrence situation during the follow-up period.Univariate and multivariate logistic regression were used to analyze the risk factors of postoperative anal fistula recurrence,and Kaplan-Meier method was ued to draw relapse-free curve.Results Compared with the control group,the observation group had longer operative time,shorter wound healing time and shorter hospital stay(P<0.05).At 1,2 and 3 months after operation,the anal resting pressure and maximum anal retraction pressure in the observation group were significantly increased,while the height of the inner mouth was significantly decreased,with statistical significance(P<0.05).There were statistically significant differences in age,body mass index,gender,regular dressing change to hospital after discharge,history of anal fistula surgery,clarity of internal opening and treatment methods between the recurrence group and the non-recurrence group(P<0.05).The results of multivariate logistic regression analysis showed that the independent risk factors for postoperative recurrence of patients with posterior high complicated anal fistula were that they didn’t regularly go to the hospital for dressing change after discharge,had a history of anal fistula operation,had unclear internal orifice and underwent thread-drawing drainage(P<0.05).The cumulative relapse-free rate of patients in the observation group and the control group was 84.58%and 67.73%respectively,and the difference was statistically significant(P<0.05).Conclusions The treatment of posterior high complex anal fistulas by intersphincter approach combined with virtual solid and hanging line has a good effect in protecting anal function and promoting wound healing.After discharge,the factors affecting postoperative recurrence in patients with posterior high complex anal fistula are not regularly changed dressing,history of anal fistula surgery,unclear internal mouth,cutting and wire hanging drainage,which should be paid attention to.