改良TROPIS术与切开挂线术治疗老年高位肛痿患者临床疗效比较

Comparison of clinical effect tendency between modified TROPIS and open and hanging technique in the treatment of elderly patients with high anal impotence

目的比较改良TROPIS术与切开挂线术治疗老年高位肛痿患者的临床疗效。方法选取川北医学院附属医院自2021年12月至2023年12月收治的128例老年高位肛痿患者为研究对象。根据不同的手术方式将患者分为A组(切开挂线术,n=62)与B组(改良TROPIS术,n=66)。记录并比较两组患者倾向性评分匹配前后的临床资料。比较两组患者手术时间、术中出血量、术后创口愈合时间、瘢痕面积、肛门Wexner评分、总有效率、术后3个月复发率,以及创面出血评分。结果倾向性评分匹配前,B组患者体质量指数高于A组,差异有统计学意义(P<0.05);两组患者Park′s分类比较,差异有统计学意义(P<0.05)。倾向性评分匹配后,两组患者临床资料比较,差异均无统计学意义(P>0.05)。B组患者手术时间、术中出血量均少于A组,差异均有统计学意义(P<0.05)。B组患者创口愈合时间短于A组,瘢痕面积,以及术后1、3个月肛门Wexner评分均低于A组,差异均有统计学意义(P<0.05)。两组患者总有效率、术后3个月复发率比较,差异均无统计学意义(P>0.05)。两组患者术后第3、7天创面出血评分均低于术后第1天,差异均有统计学意义(P<0.05);B组患者术后第1、3、7天创面出血评分均低于A组,差异均有统计学意义(P<0.05)。结论采用改良TROPIS术与切开挂线术治疗老年高位肛痿患者均可取得良好疗效,但改良TROPIS术具有手术时间短、术中出血量少、创口愈合时间短、瘢痕面积小、肛门Wexner评分与创面出血评分低等优势。

Objective To compare the clinical efficacy of modified TROPIS and incision and hanging technique in the treatment of elderly patients with high anal impotence.Methods 128 elderly patients with high anal impotence treated in the Affiliated Hospital of North Sichuan Medical College from December 2021 to December 2023 were selected as the study objects.The patients were divided into group A(incision and hanging technique,n=62)and group B(modified TROPIS,n=66)according to different surgical methods.The clinical data before and after the matching of the two groups were recorded and compared.Operation time,intraoperative blood loss,postoperative wound healing time,scar area,anal Wexner score,total effective rate,recurrence rate three months after surgery,and wound bleeding score were compared between the two groups.Results Before propensity score matching,body mass index in group B was higher than that in group A,the difference was statistically significant(P<0.05).There was statistical significance in Park′s classification between the two groups(P<0.05).After matching the propensity score,there was no statistical significance in clinical data between the two groups(P>0.05).The operative time and intraoperative blood loss in group B were less than those in group A,and the differences were statistically significant(P<0.05).Wound healing time in group B was shorter than that in group A,scar area and anal Wexner score one and three months after surgery were lower than those in group A,with statistical significance(P<0.05).There was no significant difference in the total effective rate and recurrence rate three months after operation between two groups(P>0.05).The wound bleeding scores on the 3rd and 7th day after surgery were lower than those on the 1st day after surgery,with statistical significance(P<0.05).The wound bleeding scores of group B were lower than those of group A at the 1st,3rd and 7th day after surgery,and the differences were statistically significant(P<0.05).Conclusion Both modified TROPIS and open and incision and hanging technique can achieve good results in the treatment of elderly patients with high anal impotension,but modified TROPIS has the advantages of short operation time,less intraoperative bleeding,short wound healing time,small scar area,low anal Wexner score and wound bleeding score.