改良TROPIS联合置管引流术治疗复杂性肛瘘的疗效及安全性研究

目的观察改良TROPIS联合置管引流术治疗复杂性肛瘘的疗效及安全性研究。 方法回顾性分析2019年4月~2020年10月在南京中医药大学附属南京中医院肛肠中心住院治疗的100例复杂性肛瘘（或伴脓肿）患者的临床资料，根据手术方式的不同，分为治疗组（采用改良TROPIS联合置管引流术，n=52）与对照组（采用切开挂线术，n=48）。比较两组手术时间、术中出血量、疼痛评分（术后第1、3、7天）、创面面积（手术当天、术后7天、术后14天）、创面愈合时间、肛门Wexner评分（术后3个月）、肛管静息压和肛管最大收缩压（术后3个月）、术后并发症、临床疗效及复发情况。 结果两组患者术后3个月的肛门Wexner评分、复发率比较差异均无统计学意义（均P＞0.05）。治疗组的手术时间更短（t=5.473，P＜0.05），术中出血量更少（t=5.426，P＜0.05），术后不同时点（第1、3、7天）的疼痛评分均低于对照组（t=5.873，6.665，2.162；P＜0.05），不同时点的创面面积均小于对照组（t=40.744，40.154，42.535；P＜0.05），创面愈合时间短于对照组（t=14.356，P＜0.05），术后出现排尿不畅的并发症少于对照组（χ²=4.537，P＜0.05），并发症的总发生率低于对照组（χ²=8.310，P＜0.05），术后3个月的肛管静息压和肛管最大收缩压高于对照组（t=2.348，2.180；P＜0.05），术后3个月的总有效率高于对照组（Z=4.947，P＜0.05）。 结论与切开挂线术相比，改良TROPIS联合置管引流术治疗复杂性肛瘘能缩短手术时间、减少术中出血、减轻术后肛门疼痛、缩短创面愈合时间、减少术后并发症，在保证疗效的情况下能更好地保护肛门功能。

Efficacy and safety of modified TROPIS combined with catheter drainage in the treatment of complex anal fistula

ObjectiveTo observe the efficacy and safety of modified TROPIS combined with catheter drainage in the treatment of complex anal fistula. MethodsClinical data of 100 patients with complex anal fistula (or abscess) hospitalized in The Anorectal Center of Nanjing Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from April 2019 to October 2020 were retrospectively analyzed. According to different surgical methods, they were divided into treatment group (modified TROPIS combined with catheter drainage, n=52) and the control group (cutting seton, n=48). The operation time, intraoperative blood loss, pain score (1, 3, 7 days) after operation, wound area (on the day of surgery, postoperative 7 days, 14 days) after operation, wound healing time, anal Wexner score (3 months) after operation, anal canal resting pressure, anal canal maximum systolic blood pressure (3 months) after operation, postoperative complications, clinical efficacy and relapse were compared between the two groups. ResultsThere were no significant differences in anal Wexner score and recurrence rate between 2 groups 3 months after surgery (all P＞0.05). The operation time of the treatment group was shorter (t=5.473, P＜0.05), the amount of intraoperative blood loss was less (t=5.426, P＜0.05), and the pain score at different postoperative points (1st, 3rd and 7th day) of the treatment group were lower than that of the control group (t=5.873, 6.665, 2.162; P＜0.05), the wound area at different time points was smaller than that in the control group (t=40.744, 40.154, 42.535; P＜0.05), the wound healing time was shorter than that of the control group (t=14.356, P＜0.05), the complications of postoperative dysuria were less than that of the control group (χ²=4.537, P＜0.05), and the total incidence of complications was lower than that of the control group (χ²=8.310, P＜0.05). The anal canal resting pressure and maximum anal systolic pressure 3 months after operation were higher than those in the control group (t=2.348, 2.180; P＜0.05), the total effective rate 3 months after operation was higher than that of control group (Z=4.947, P＜0.05). ConclusionCompared with suture incision, modified TROPIS combined with catheter drainage in the treatment of complex anal fistula can shorten the operation time, reduce intraoperative bleeding, relieve postoperative anal pain, shorten wound healing time, reduce postoperative complications, and better protect anal function while ensuring curative effect.