基于倾向性评分匹配法评估切开挂线对口引流术与传统切开挂线术治疗老年高位复杂性肛瘘的效果  

Evaluation of effect of fistulotomy with seton drainage and traditional seton fis tulotomy in treatment of high complex anal fistula in the elderly based on propensity score matching

作　　者：田磊[1] 秦澎湃[1] 何毅 穆世佳 Tian Lei;Qin Pengpai;He Yi;Mu Shijia(Department of Anorectal Surgery,Beijing Rectum Hospital,Beijing 100120,China)

机构地区：[1]北京市肛肠医院肛肠外科,北京100120

出　　处：《中华老年多器官疾病杂志》2024年第8期607-610,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：北京市医院管理中心培育计划(PX20200701)。

摘　　要：目的基于倾向性评分匹配法评估切开挂线对口引流术(FSD)与传统切开挂线术(TSF)治疗老年高位复杂性肛瘘的效果。方法回顾性分析2020年3月至2023年3月北京市肛肠医院肛肠外科收治的220例患者的临床资料,其中FSD组117例,TSF组103例,采用1∶1倾向性评分匹配法筛选出82对匹配队列,比较两组患者术后疗效、恢复、疼痛程度、肛肠动力学、肛管功能及复发情况。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用logistic回归模型计算倾向性评分,近邻匹配法进行1∶1匹配。结果匹配后FSD组术后24 h视觉模拟评分法(VAS)评分低于TSF组[(4.21±1.18)和(5.04±1.36)分],临床总有效率高于TSF组[96.34%(79/82)和87.80%(72/82)],创面愈合时间短于TSF组[(12.34±2.45)和(14.67±2.89)d],差异均有统计学意义(P<0.05)。术后1个月,FSD组肛管功能长度、最大耐受量及初始感觉阈值均大于TSF组[(2.86±0.34)和(2.31±0.46)cm;(135.21±19.87)和(119.52±20.13)ml;(25.16±2.57)和(22.89±2.92)ml],差异均有统计学意义(P<0.05)。术后1个月,FSD组Wexner评分低于TSF组[(0.92±0.27)和(1.17±0.35)分];复发率低于TSF组[3.66%(3/82)和12.20%(10/82)],差异有统计学意义(P<0.05)。结论FSD治疗老年高位复杂性肛瘘疗效确切,术后创面愈合快、对肛管功能损伤小,且复发率低。Objective To evaluate the effect of fistulotomy with seton drainage(FSD)versus traditional seton fistulotomy(TSF)in the treatment of high complex anal fistula in the elderly based on propensity score matching.Methods The clinical data of 220 patients in the Department of Anorectal Surgery of Beijing Rectum Hospital from March 2020 to March 2023 were retrospectively analyzed,including 117 in the FSD group and 103 in the TSF group.Propensity score matching was used to select a matched cohort of 82 pair(1∶1).The postoperative efficacy,recovery,pain degree,anorectal dynamics,anal canal function and recurrence were compared between the two groups.SPSS 22.0 was used for data analysis.According to the data type,t test or Chi-square test were performed for intergroup comparison.Logistic regression model was used to calculate the propensity score,and the nearest neighbor matching method was used for 1:1 matching.Results After matching at 24 h postoperatively,the visual analogue scale(VAS)score in the FSD group was lower than that in the TSF group[(4.21±1.18)vs(5.04±1.36)points],the total clinical effective rate in the FSD group was higher than that in the TSF group[96.34%(79/82)vs 87.80%(72/82)],and the wound healing time in the FSD group was shorter than that in the TSF group[(12.34±2.45)vs(14.67±2.89)d];all the differences were statistically significant(P<0.05).At 1 month postoperatively,the FSD group had greater anal function length[(2.86±0.34)vs(2.31±0.46)cm],maximum tolerance dose[(135.21±19.87)vs(119.52±20.13)ml]and initial sensory threshold[(25.16±2.57)vs(22.89±2.92)ml]than the TSF group,and the differences were statistically significant(P<0.05).At 1 month postoperatively,the Wexner score was lower in the FSD group than that in the TSF group[(0.92±0.27)vs(1.17±0.35)pionts],and the recurrence rate in the FSD group was also lower[3.66%(3/82)vs 12.20%(10/82)];and the difference was statistically significant(P<0.05).Conclusion FSD is effective in the treatment of high complex anal fistula in the elderly,w

关 键 词：老年人 高位复杂性肛瘘 切开挂线对口引流术 倾向性评分匹配法 

分 类 号：R592[医药卫生—老年医学] R657.16[医药卫生—内科学]