视频辅助性肛瘘治疗与切开挂线术治疗复杂性肛瘘的手术效果比较：倾向评分匹配分析-回顾性队列研究。
Comparison of surgical outcomes between video-assisted anal fistula treatment and fistulotomy plus seton for complex anal fistula: A propensity score matching analysis - Retrospective cohort study.
机构信息
Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China; Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China.
出版信息
Int J Surg. 2020 Mar;75:99-104. doi: 10.1016/j.ijsu.2020.01.137. Epub 2020 Feb 1.
BACKGROUND
Video-assisted anal fistula treatment (VAAFT) is a new minimally invasive technique for treating complex anal fistula (CAF). This study aimed to compare the efficacy and safety of VAAFT with fistulotomy plus seton (FPS) for treatment of CAF.
MATERIALS AND METHODS
We included 148 patients with CAF receiving surgical treatment at our hospital between January 2017 and December 2018. Propensity score matching (PSM) analysis was conducted with patients' baseline characteristics, and surgical outcomes were compared between the matched groups. Logistic analysis was performed to identify the risk factors for fistula recurrence after VAAFT.
RESULTS
Among the study population, 68 and 80 patients underwent VAAFT and FPS, respectively. After PSM, 64 matched pairs of patients were created with no significant differences in baseline characteristics. Compared with FPS, VAAFT had greater efficiency of locating internal openings (90.6% vs. 100%), less intraoperative blood loss (26 ± 15 vs. 12 ± 5 mL), lower incidence of postoperative bleeding (10.9% vs. 1.5%), shorter postoperative hospital stay (6.8 ± 5.1 vs. 5.0 ± 3.3 days), reduced postoperative pain, and decreased wound secretion (all P < 0.05). VAAFT showed a significantly lower Wexner incontinence score than FPS (0.9 ± 1.7 vs. 1.9 ± 2.6, P = 0.003) at 3 months postoperatively, but no significant difference in the healing rate was observed either at 3-month or 1-year (P = 1.000) follow-up. A total of 12 patients (17.6%) developed fistula recurrence after VAAFT, and logistic analysis revealed that multiple fistula tracts, prolonged operating time and severe postoperative wound secretion were independent risk factors (odds risk = 2.18, 3.25 and 3.04, respectively, all adjusted P < 0.05).
CONCLUSION
Compared with FPS, VAAFT offers some advantages for treatment of CAF, including minimal damage, less pain, rapid recovery, fewer complications and better sphincter preservation.
背景
视频辅助肛瘘治疗（VAAFT）是一种治疗复杂性肛瘘（CAF）的新微创技术。本研究旨在比较 VAAFT 与切开挂线术（FPS）治疗 CAF 的疗效和安全性。
材料与方法
我们纳入了 2017 年 1 月至 2018 年 12 月在我院接受手术治疗的 148 例 CAF 患者。采用倾向评分匹配（PSM）分析患者的基线特征，并比较匹配组的手术结果。采用逻辑分析识别 VAAFT 后肛瘘复发的危险因素。
结果
在研究人群中，分别有 68 例和 80 例患者接受了 VAAFT 和 FPS 治疗。经过 PSM 后，创建了 64 对匹配的患者，其基线特征无显著差异。与 FPS 相比，VAAFT 具有更高的定位内口效率（90.6% 比 100%），术中出血量更少（26±15 比 12±5 mL），术后出血发生率更低（10.9% 比 1.5%），术后住院时间更短（6.8±5.1 比 5.0±3.3 天），术后疼痛减轻，伤口分泌物减少（均 P<0.05）。VAAFT 在术后 3 个月时的 Wexner 失禁评分明显低于 FPS（0.9±1.7 比 1.9±2.6，P=0.003），但在 3 个月和 1 年（P=1.000）随访时，愈合率无显著差异。VAAFT 后共有 12 例（17.6%）患者发生肛瘘复发，逻辑分析显示，多发瘘管、手术时间延长和严重术后伤口分泌物是独立的危险因素（优势比分别为 2.18、3.25 和 3.04，均 P<0.05）。
结论
与 FPS 相比，VAAFT 治疗 CAF 具有创伤小、疼痛轻、恢复快、并发症少、括约肌保护好等优点。
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