1554例肛瘘患者临床病理特征及术后复发危险因素分析  

Clinicopathologic characteristics of 1,554 patients with anal fistula and risk factors for recurrence

作　　者：齐顺利 陈希琳[1] 于晓倩 于国志[2] 孙平 Qi Shunli;Chen Xilin;Yu Xiaoqian;Yu Guozhi;Sun Ping(Department of Pathology,Beijing Anorectal Hospital—Beijing Er Long Lu Hospital,Beijing 100120,China;Department of Anorectal Diseases,Beijing Anorectal Hospital—Beijing Er Long Lu Hospital,Beijing 100120,China)

机构地区：[1]北京市肛肠医院(北京市二龙路医院)病理科,北京100120 [2]北京市肛肠医院(北京市二龙路医院)肛肠科,北京100120

出　　处：《结直肠肛门外科》2021年第3期254-257,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的分析1554例肛瘘患者的临床病理特征,探讨肛瘘患者术后复发的危险因素。方法回顾性分析本院2018年1月至2020年10月收治的1554例肛瘘患者的临床资料,分析1554例肛瘘患者临床病理特征(临床分型、病理分型)并探讨肛瘘患者术后复发的危险因素。结果1554例患者中,低位肛瘘患者为547例(35.2%)、高位肛瘘患者为1007例(64.8%),单纯性肛瘘患者为714例(45.9%)、复杂性肛瘘患者为840例(54.1%);病理分型:普通腺源性肛瘘1143例、异物肉芽肿肛瘘386例、结核性肛瘘2例、肛瘘癌变2例、克罗恩病肛瘘10例、表皮样囊肿性肛瘘4例、肛瘘伴鳞状上皮非典型增生2例、肛瘘伴瘘管壁组织上皮化5例。随访3个月,术后复发50例,复发率为3.22%。单因素分析结果显示,复发组年龄、男性、BMI、特殊病因肛瘘(克罗恩病肛瘘、结核性肛瘘、肛瘘癌变)、瘘管数目、病程与复发相关(均P<0.05)。多因素Logistic回归分析结果显示BMI≥24 kg/m2、年龄≥60岁、特殊病因肛瘘、病程>1年、瘘管数目>1个、男性是肛瘘患者术后复发的危险因素。结论BMI≥24 kg/m2、年龄≥60岁、病程>1年、瘘管数目>1个、男性、特殊病因肛瘘是肛瘘患者术后复发的危险因素,有以上复发危险因素的患者应作为重点临床筛查预防对象,患者应增强对肛瘘的临床及病理诊断的重视程度,定期到院检查,避免延误时机,合理控制体质量,降低肛瘘复发风险。Objectives To analyze the clinicopathologic characteristics of 1,554 patients with anal fistula and investigate the risk factors for recurrence.Methods This was a retrospective analysis of 1,544 patients with anal fistula treated at our hospital between January 2018 and October 2020.We investigated the risk factors for postoperative recurrence.Results Of the 1,544 patients,547(35.2%)were low anal fistula,and 1,007(64.8%)were high anal fistula,714(45.9%)were simple fistula,and 840(54.1%)were complex fistula.The causes of fistula included anal gland infection(n=1,143),foreign body granuloma(n=386),tuberculosis(n=2),malignant neoplasm(n=2),Crohn’s disease(n=10),epidermoid cyst(n=4),squamous atypical hyperplasia(n=2)and fistula with epithelization(n=5).Patients were followed up for 3 months,and 50 patients experienced recurrence with a recurrence rate of 3.22%.Univariate analyses showed that recurrence was significantly associated with age,male,body mass index(BMI),special causes(Crohn’s disease,tuberculosis,and malignant neoplasm),number of fistulas,and disease duration(P<0.05).Multiple Logistic aggression analysis showed that BMI≥24 kg/m2,age≥60 years,special causes,disease duration>1 year,number of fistulas>1,and male were independent risk factors for recurrence.Conclusion BMI≥24 kg/m2,age≥60 years,special causes,disease duration>1 year,number of fistulas>1,and male were independent risk factors for recurrence.Patients with these risk factors should be targeted for screening.Additional efforts should be devoted to increasing the awareness of clinicopathologic characteristics of anal fistulas.Patients should attend regular visits and properly manage their BMI to avoid delayed treatment and recurrence.

关 键 词：肛瘘 危险因素 复发 病理特点 

分 类 号：R657.16[医药卫生—外科学]