中国中西医结合外科杂志2024，Vol.30Issue(5)：671-676,6.DOI:10.3969/j.issn.1007-6948.2024.05.013
改良TROPIS术治疗高位肛瘘的手术结局及其危险因素分析
Analysis of surgical outcomes and postoperative risk factors of modified TROPIS procedure for high anal fistula
摘要
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 a certain 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.关键词
高位肛瘘/改良TROPIS术/复发/危险因素/回顾性队列研究Key words
High anal fistula/modified TROPIS/recurrence/risk factors/retrospective cohort study分类
医药卫生引用本文复制引用
郭姗,郑雪平..改良TROPIS术治疗高位肛瘘的手术结局及其危险因素分析[J].中国中西医结合外科杂志,2024,30(5):671-676,6.基金项目
南京市卫生科技发展专项资金项目(YKK21197) （YKK21197）
南京市卫生科技发展专项资金项目(YKK22175) （YKK22175）
南京市"十三五"规划名中医工作室研究建设项目(ZXP-2019-NJ) （ZXP-2019-NJ）
