Abstract:

Objective　To explore the clinical efficacy and application value of modified ligation of intersphincteric fistula tract (LIFT) in the treatment of transsphincteric anal fistula. Methods　A retrospective controlled study was conducted. A total of 121 patients with transsphincteric anal fistula who underwent surgical treatment in the Department of Anorectal Surgery at Shangluo Traditional Chinese Medicine Hospital from January 2020 to December 2022 were selected as the study subjects. According to different surgical methods, patients were divided into an observation group (61 cases, receiving modified LIFT) and a control group (60 cases, receiving traditional LIFT). The observation group included 39 males and 22 females, with an average age of (42.65±8.27) years; the control group included 40 males and 20 females, with an average age of (43.12±7.96) years. Surgical-related indicators (operation time, intraoperative blood loss, length of hospital stay, wound healing time), postoperative pain scores [Visual Analog Scale (VAS)], postoperative complications, anal function assessment, and recurrence rates were compared between the two groups. Statistical analysis was conducted using χ² ,t and F tests and Fisher exact probability method. Results　The observation group had an operation time, intraoperative blood loss, length of hospital stay, and wound healing time of (45.37±8.62) minutes, (16.24±3.58) ml, (5.12±1.03) days, and (16.43±3.25) days, respectively, while the control group had (58.64±10.15) minutes, (25.37±4.76) ml, (7.38±1.42) days, and (21.87±4.19) days. All differences were statistically significant (t=7.84, 12.45, 10.23, 8.33, all P<0.001). Postoperative VAS scores at 24, 48, and 72 hours for the observation group were (4.25±0.83, 3.18±0.67, 2.04±0.52) points, which were all lower than those of the control group [(5.67±1.04, 4.52±0.89, 3.26±0.75) points], with all differences being statistically significant (all P<0.001). The total incidence of postoperative complications in the observation group was lower than that in the control group [6.56% (4/61) vs. 18.33% (11/60)] (χ²=4.13, P=0.042). At 3 months postoperatively, the Wexner anal function score in the observation group was (1.24±0.58) points, compared to (1.38±0.67) points in the control group, with no statistically significant difference (t=1.24, P=0.216). After 12 months of follow-up, there was no significant difference in the recurrence rate between the two groups(P>0.05). Conclusions　Modified LIFT in the treatment of transsphincteric anal fistula has the advantages of less surgical trauma, faster postoperative recovery, less pain and fewer complications. The recurrence rate has a decreasing trend, which can protect the function of anal sphincter and has high clinical application value.

Key words:

Transsphincteric anal fistula, Improved ligation of intersphincteric fistula tract, Curative effect, Complications, Recurrence rate

摘要：

目的　探讨改良括约肌间瘘管结扎术（LIFT）治疗经括约肌肛瘘的临床疗效与应用价值。方法　本研究为回顾性对照研究。选取2020年1月至2022年12月在商洛市中医医院肛肠外科接受手术治疗的121例经括约肌肛瘘患者作为研究对象，根据手术方式不同将患者分为观察组（61例）与对照组（60例）。观察组男39例，女22例，年龄（42.65±8.27）岁，采用改良LIFT术治疗。对照组男40例，女20例，年龄（43.12±7.96）岁，采用传统LIFT术治疗。比较两组手术相关指标（手术时间、术中出血量、住院时间、伤口愈合时间）、术后疼痛评分［视觉模拟评分法（VAS）］、术后并发症、肛门功能（Wexner评分）、复发率。采用χ²、t、F检验及Fisher确切概率法进行统计分析。结果　观察组患者手术时间、术中出血量、住院时间、伤口愈合时间分别为（45.37±8.62）min、（16.24±3.58）ml、（5.12±1.03）d、（16.43±3.25）d，对照组分别为（58.64±10.15）min、（25.37±4.76）ml、（7.38±1.42）d、（21.87±4.19）d，差异均有统计学意义（t=7.84、12.45、10.23、8.33，均P<0.001）。观察组患者术后24、48、72 h的VAS评分分别为（4.25±0.83、3.18±0.67、2.04±0.52）分，均低于对照组的（5.67±1.04、4.52±0.89、3.26±0.75）分，差异均有统计学意义（均P<0.001）。观察组患者术后并发症总发生率低于对照组［6.56%（4/61）比18.33%（11/60）］（χ²=4.13，P=0.042）。术后3个月，观察组Wexner评分为（1.24±0.58）分，对照组为（1.38±0.67）分，差异无统计学意义（t=1.24，P=0.216）。随访12个月，两组患者复发率差异无统计学意义（P>0.05）。结论　改良LIFT术治疗经括约肌肛瘘具有手术创伤小、术后恢复快、疼痛程度较轻、并发症少等优势，复发率呈降低趋势，可较好保护肛门括约肌功能，临床应用价值较高。

关键词:

经括约肌肛瘘, 改良括约肌间瘘管结扎术, 疗效, 并发症, 复发率