摘要
Abstract
Objective To analyze the efficacy of modified transanal opening of the intersphincteric space(TROPIS)in the treatment of patients with high anal fistula and its effect on anal function.Methods A total of 128 patients with high anal fistula admitted to our department from August 2020 to July 2023 were divided into two groups using a random number table method.One group received traditional incision and thread-drawing therapy(the control group,64 cases),and the other group was treated with modified TROPIS(the observation group,64 cases).The total effective rate,perioperative indicators,incidence of postoperative complications,and postoperative anal function were compared between the two groups.Furthermore,accord-ing to the anal function status 1 year after surgery,the 128 patients were divided into an anal function-decline group and a non-decline group.Multivariate Logistic regression analysis was used to identify the influencing fac-tors of postoperative anal function decline in patients with high anal fistula.Results The total effective rate of the observation group was 96.88%(62/64),which was significantly higher than that of the control group(85.94%,55/64),with a statistically significant difference(P<0.05).The intraoperative blood loss and scar area in the observation group were smaller than those in the control group,and the operation time,hospital stay,and wound healing time were all shorter than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was 12.50%(8/64),which was lower than 29.69%(19/64)in the control group(P<0.05).The postoperative Wexner fecal incontinence score of the observation group was lower than that of the control group(P<0.05).The body mass index(BMI),proportion of patients with multiple fistulas,proportion of patients with unclear internal orifices,and proportion of patients receiving tradi-tional incision and thread-drawing therapy in the anal function-decline group were all higher than those in the non-decline group(P<0.05).Multivariate analysis showed that high BMI(OR=1.848,95%CI:1.369−2.494),unclear internal orifices(OR=2.472,95%CI:1.667−3.665),and traditional incision and thread-drawing therapy(OR=3.013,95%CI:1.901−4.776)were independent risk factors for postoperative anal function decline in patients with high anal fistula(P<0.05).Conclusion Modified TROPIS has a signifi-cant efficacy in the treatment of high anal fistula,which can improve perioperative indicators,reduce the inci-dence of complications,and alleviate postoperative anal function injury.BMI≥24 kg/m²,unclear internal ori-fices,and traditional incision and thread-drawing therapy are risk factors for postoperative anal function decline in patients with high anal fistula.关键词
高位肛瘘/改良TROPIS/疗效/肛门功能Key words
High anal fistula/Modified TROPIS/Efficacy/Anal function
