改良的保留肛门括约肌虚挂线治疗Crohn病肛瘘的效果及术前伴直肠狭窄的因素分析  

Efficacy of improved anal sphincter retention virtual-hanging in treating anal fistula in Crohn disease and analysis of factors affecting preoperative rectal stenosis

作　　者：伍军 项武军 陈震宇 WU Jun;XIANG Wujun;CHEN Zhenyu(Department of Anorectal Surgery,The Third People’s Hospital of Bengbu,Bengbu,Anhui 233000,P.R.China)

机构地区：[1]蚌埠市第三人民医院肛肠外科,安徽蚌埠233000

出　　处：《中国普外基础与临床杂志》2024年第7期863-869,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结Crohn病(Crohn disease,CD)肛瘘术前伴直肠狭窄的发生情况并分析其影响因素,同时探讨改良的保留肛门括约肌虚挂线(简称“改良虚挂线法”)治疗CD肛瘘的效果。方法回顾性收集2019年1月至2021年6月期间蚌埠市第三人民医院收治且采用改良虚挂线法治疗的CD肛瘘患者,总结术前伴直肠狭窄发生情况和治疗效果,同时根据多因素logistic回归分析的变量采用卡方自动交互检测法建立决策树模型。结果本研究共收集到CD肛瘘患者234例,其中术前伴直肠狭窄发生率为22.2%(52/234)。多因素logistic回归分析发现,术前伴直肠炎症、蒙特利尔分型B2型、瘘管范围位于肛提肌上方、瘘管数量单条且有分支或多条、淋巴细胞计数≥6.03×10^(9)/L、血小板计数≥0.61×10^(9)/L、红细胞沉降率≥39.11 mm/h、C反应蛋白≥5.13 mg/L和脑钠肽≥313.26 ng/L的患者术前伴直肠狭窄发生的概率增高(P<0.05)。对于术前伴或不伴直肠狭窄患者,采用改良虚挂线法治疗后的CD活动指数评分、肛周CD活动指数评分和肛管静息压均较治疗前呈现降低趋势、肛管最大收缩压呈现升高趋势。建立的决策树模型共18个节点,9个终端节点,决策树模型的增益图从0%开始逐渐增长,最终到达100%;指数图从198%开始维持较高的水平后快速降低至100%;受试者操作特征曲线下面积为0.852[95%CI(0.821,0.908)],其敏感度为84.35%、特异度为82.33%。结论CD肛瘘患者术前伴直肠狭窄发生率较高,采用改良虚挂线法治疗效果较好,对于术前伴直肠炎症、蒙特利尔分型B2型、瘘管范围位于肛提肌上方、瘘管数量单条且有分支或多条且淋巴细胞计数、血小板计数、红细胞沉降率、C反应蛋白及脑钠肽水平较高者应关注其术前伴直肠狭窄的情况,本研究根据这些重点关注的因素构建的决策树模型对术前是否伴直肠狭窄的区分度较好。Objective To summarize the occurrence of anal fistula in Crohn disease(CDAF)accompanying with preoperative rectal stenosis and analyze its influencing factors.Meanwhile to explore the effect of improved anal sphincter retention virtual-hanging(hereafter this text will be abbreviated as virtual-hanging)for treatment of CDAF.Methods The CDAF patients admitted to the Third People’s Hospital of Bengbu from January 2019 to June 2021 were retrospectively collected,who were treated with virtual-hanging.Meanwhile the multivariable logistic regression analysis was used to identify the risk factors for accompanying with preoperative rectal stenosis and which were used to establish a decision tree model by Chi squared automatic interaction detection method.Results A total of 234 patients with CDAF were collected,and the incidence of accompanying with preoperative rectal stenosis was 22.2%(52/234).The multivariate logistic regression analysis found that the patients with preoperative proctitis,Montreal subtype B2,fistula located above the musculi levator ani(MLA),single fistula accompanied by branches or multiple fistulas,lymphocyte count(Lym)≥6.03×10^(9)/L,platelet count(PLT)≥0.61×10^(9)/L,erythrocyte sedimentation rate(ESR)≥39.11 mm/h,C-reactive protein(CRP)≥5.13 mg/L,and brain natriuretic peptide(BNP)≥313.26 ng/L had higher probability of accompanying with preoperative rectal stenosis(P<0.05).For the patients with or without preoperative rectal stenosis,the CD activity index score and perianal CD activity index score,and anal resting pressure all showed decreasing trends after treatment with the virtual-hanging,and the anal maximal contraction pressure showed a increasing trend as compared to before treatment.The decision tree consisted 18 nodes and 9 terminal nodes.The gain map of the decision tree model gradually increased from 0%to 100%;The index chart maintained a high level starting from 198%and then rapidly decreased to 100%.The area under the receiver operating characteristic curve of the decision tre

关 键 词：改良的保留肛门括约肌虚挂线 克罗恩病 肛瘘 疗效 直肠狭窄 

分 类 号：R657.16[医药卫生—外科学]