肛周脓肿患者切开引流术后复发形成肛瘘的影响因素分析

Analysis of Influencing Factors on the Recurrence of Anal Fistula in Patients with Perianal Abscess after Incision and Drainage Surgery

目的 分析肛周脓肿患者切开引流术后复发形成肛瘘的影响因素。方法 选取2021年7月—2023年6月120例行切开引流的肛周脓肿患者为观察对象,根据术后复发形成肛瘘情况分为发生肛瘘组(n=38)和未发生肛瘘组(n=82)。收集2组患者的一般资料及临床资料,采用多因素logistic回归分析探讨术后复发形成肛瘘的影响因素。建立logistic回归方程评价模型预测术后复发形成肛瘘的灵敏度、特异度和准确度。结果 发生肛瘘组患者的体质量指数(BMI)、单纯性切开引流比例、致病菌为肠道来源、深部脓肿和马蹄形脓肿比例明显高于未发生肛瘘组(P<0.05)。多因素logistic回归分析显示,BMI、致病菌为肠道来源、深部脓肿和马蹄形脓肿为肛周脓肿患者术后复发形成肛瘘的危险因素,手术方式(根治性切开引流)为肛周脓肿患者术后复发形成肛瘘的保护因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,logistic回归模型预测术后复发形成肛瘘的曲线下面积(AUC)为0.800(95%CI:0.728~0.872),灵敏度为87.50%、特异度为72.50%。结论 肛周脓肿患者切开引流术后复发形成肛瘘发生率较高。高BMI、致病菌为肠道来源、深部脓肿和马蹄形脓肿为术后复发形成肛瘘的危险因素,早期筛查术后复发形成肛瘘的高危患者并给予干预,有助于降低其发生率。

Objective Analyze the influencing factors of anal fistula recurrence in patients with perianal abscess after incision and drainage surgery.Methods 120 patients with perianal abscess who underwent incision and drainage from July 2021 to June 2023 were selected as the observation subjects.According to the occurrence of anal fistula after surgery,they were divided into a group with anal fistula(n=38)and a group without anal fistula(n=82).General and clinical data of the two groups of patients were collected,and multivariate logistic regression analysis was used to analyze the influencing factors of postoperative recurrence of anal fistula in patients.Establish a logistic regression equation to evaluate the sensitivity,specificity,and accuracy of the model for predicting postoperative recurrence and formation of anal fistula.Results The body mass index(BMI)value of patients with anal fistula was significantly higher than that of those without anal fistula,and the proportion of simple incision and drainage was significantly higher than that of those without anal fistula.The proportion of pathogenic bacteria including intestinal origin,deep abscess,and horseshoe shaped abscess was significantly higher than that of those without anal fistula(P<0.05).Multivariate logistic regression analysis showed that BMI,intestinal origin of pathogenic bacteria,deep abscess,and horseshoe abscess were risk factors for postoperative recurrence and formation of anal fistula in patients with perianal abscess.Surgical approach(radical incision and drainage)was a protective factor for postoperative recurrence and formation of anal fistula in patients with perianal abscess(P<0.05).The receiver operating characteristic(ROC)curve analysis results showed that the area under the curve(AUC)of the logistic regression model predicting postoperative recurrence and formation of anal fistula was 0.800(95%CI:0.728-0.872),with a sensitivity of 87.50%and a specificity of 72.50%.Conclusion The incidence of recurrent anal fistula is higher in patients with perianal abscess after incision and drainage surgery.Among them,high BMI,pathogenic bacteria originating from the intestine,deep abscess,and horseshoe abscess are risk factors for postoperative recurrence of anal fistula.Early screening of high-risk patients with postoperative recurrence of anal fistula and early intervention can help reduce its incidence.