| 摘要: |
| 目的:评估改良TROPIS 术治疗高位肛瘘的疗效，探讨影响改良TROPIS 术治疗高位肛瘘患者术后结局的危险因素。方法:采用回顾性队列研究方法，对南京中医药大学附属南京中医院行手术治疗的325 例高位肛瘘患者病例资料进行整理分析，按照手术方式不同分为观察组(改良TROPIS 术组153 例)与对照组(传统切开挂线术组172 例)。统计分析患者基本资料信息，比较两组术后复发率、并发症发生率及卫生经济学指标。采用Logistic 回归模型探讨不同临床参数对手术结局的影响，并计算观察组术后累积未复发率。结果:观察组19 例复发，复发率为12.42%，对照组26 例复发，复发率为15.12%，两组差异无统计学意义(p>0.05)。观察组在术后并发症发生率、卫生经济学等方面均低于对照组(P＜0.05)。在患者满意度调查方面，观察组优于对照组(P＜0.05)。多因素Logistic 回归分析提示，肛瘘类型(HR=4.650, 95%CI:1.428~15.139)、内口因素(HR=13.567,95%CI:3.652~50.399)、是否遵医嘱定期换药(HR=0.150, 95%CI:0.039~0.581)、既往肛瘘手术史(HR=3.255, 95%CI:1.154~9.179)是高位肛瘘患者改良TROPIS 术治疗后复发的影响因素。结论:改良TROPIS 术治疗高位肛瘘安全性高，在保证一定治愈率的同时减少术后并发症发生，加快了床位周转率，提高了患者的满意度，值得临床推广。复杂性肛瘘、内口不明、未遵医嘱换药、既往有肛瘘手术史的高位肛瘘患者复发率显著升高，在临床应用改良TROPIS 术时应注意对此类患者加强管理，以提高治愈率。 |
| 关键词: 高位肛瘘 改良TROPIS 术 复发 危险因素 回顾性队列研究 |
| DOI：10.3969/j.issn.1007-6948.2024.05.013 |
| 投稿时间：2023-12-03 |
| 基金项目:南京市卫生科技发展专项资金项目(YKK21197)；南京市卫生科技发展专项资金项目(YKK22175)；南京市“十三五”规划名中医工作室研究建设项目(ZXP-2019-NJ) |
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| Analysis of surgical outcomes and postoperative risk factors of modified TROPIS procedure for high anal |
| fistula GUO-shan,ZHENG Xue-ping |
| Nanjing University of Chinese Medicine, Nanjing (210029), China |
| Abstract: |
| Objective To assess the efficacy of modified TROPIS in treating high anal fistula, and to explore the risk factors affecting the postoperative outcomes of patients with high anal fistula treated with modified TROPIS. Methods Using the research method of retrospective cohort study, 325 patients with high anal fistula who underwent surgical treatment were collected and divided into the observation group(treated with modified TROPIS, n=153)and the control group(treated with traditional surgery, n=172)according to the different surgical methods. The basic information of patients was statistically analysed, and the postoperative recurrence rate, complication rate were observed and recorded. Logistic regression analysis was used to explore the effect of clinical parameters in the observation group and calculate the cumulative non-recurrence rate after surgery in the observation group. Results 19 cases in the observation group had recurrence, with a recurrence rate of 12.42%, and 26 cases in the control group had recurrence, with a recurrence rate of 15.12%, and the difference between the two groups was not statistically significant (P>0.05). The observation group was lower than the control group in terms of the incidence of postoperative complications, length of surgery, length of hospitalisation,and hospital costs (P<0.05). In terms of patients’satisfaction survey, the observation group was better than the control group (P<0.05). Multifactorial Logistic regression analysis suggested that complex anal fistula (HR=4.650, 95% CI:1.428 -15.139),unclear internal orifice (HR=13.567, 95% CI:3.652-50.399), failure to comply with the doctor's instructions for regular medication change (HR=0.150, 95% CI:0.039-0.581), previous anal fistula surgery history(HR=3.255, 95% CI:1.154-9.179) were independent risk factors for recurrence after modified TROPIS procedure treatment in patients with high anal fistula. Conclusion The modified TROPIS procedure is safe to ensure acertain cure rate while reducing the occurrence of postoperative complications, and accelerating the bed turnover rate, and improving patient satisfaction, which is worthy of clinical promotion. Significantly higher recurrence rates in patients with complex anal fistulas, unknown internal orifices, non-compliance with medication changes,and history of previous anal fistula surgery, and attention should be paid to strengthening the management of such patients when applying modified TROPIS in the clinical application in order to improve the cure rate. |
| Key words: High anal fistula modified TROPIS recurrence risk factors retrospective cohort study |
