目的 探究改良括约肌间瘘管结扎术(Lift-plug)在经括约肌肛瘘(TSAF)病人治疗中的应用优势.方法 回顾性收集2020年3月至2022年3月首都医科大学附属北京潞河医院110例TSAF病人临床资料,根据手术方法分为两组,传统组55例行Lift,Lift-plug组55例行Lift-plug术.比较两组围术期指标、临床疗效、并发症、复发率及神经源性炎症因子[P物质(SP)、神经生长因子(NGF)、前列腺素E2(PGE2)]、肠道微生态[D-乳酸、二胺氧化酶(DAO)]、肛门括约肌功能(肛门功能指数评分、Wexner尿失禁评分).结果 Lift-plug组手术时间[(20.22±3.34)min比(23.89±4.11)min]、创面愈合时间[(25.50±3.38)d比(30.31±4.56)d]、住院时间[(5.88±0.82)d比(6.42±1.03)d]短于传统组,术后1 d VAS评分[(2.41±0.35)分比(3.02±0.42)分]低于传统组(P<0.05);术后1 d Lift-plug组血清SP、NGF、PGE2水平低于传统组(P<0.05);术后1 d、3 d 两组D-乳酸、血浆DAO水平均差异无统计学意义(P>0.05);术后1个月、3个月Lift-plug组肛门功能指数、Wexner尿失禁评分均低于传统组(P<0.05);术后3个月,Lift-plug组治疗总有效率高于传统组(P<0.05);术后3个月两组并发症发生率及复发率比较差异无统计学意义(P>0.05).结论 Lift-plug术治疗TSAF病人可优化手术,减轻神经源性炎症反应,减轻早期疼痛,改善括约肌功能,增强临床疗效,且具有较高安全性.
Effect of lift-plug surgery on intestinal microbiota,complications,and sphincter function in patients with transanal sphincter fistula
Objective To explore the application advantages of ligation of the intersphincteric fistula tract plus bioprosthetic anal fis-tula plug(Lift-plug)in the treatment of transsphincter anal fistula(TSAF).Methods The clinical data of 110 patients with TSAF who were treated in Beijing Luhe Hospital Affiliated to Capital Medical University from March 2020 to March 2022 were retrospectively col-lected,and they were assigned into two groups according to the surgical methods.The conventional surgery group(n=55)underwent Lift surgery,while the Lift-plug group(n=55)underwent Lift-plug surgery.A comparison was made between the two groups of perioperative indexes,clinical efficacy,complications,recurrence rate,neurogenic inflammatory factors[substance P(SP),nerve growth factor(NGF),prostaglandin E2(PGE2)],intestinal microecology[D-lactic acid,diamine oxidase(DAO)],and anal sphincter function(anal function in-dex score,Wexner urinary incontinence score).Results The operation time[(20.22±3.34)min vs.(23.89±4.11)min],wound healing time[(25.50±3.38)d vs.(30.31±4.56)d]and hospital stay[(5.88±0.82)d vs.(6.42±1.03)d]of the Lift-plug group were shorter than those of the conventional surgery group,and the VAS score of the Lift-plug group was lower than that of the conventional surgery group one day after surgery[(2.41±0.35)scores vs.(3.02±0.42)scores](P<0.05).The levels of SP,NGF and PGE2 in the Lift-plug group were lower than those in the conventional surgery group one day after surgery(P<0.05).There were no significant differences in D-lactic acid and plasma DAO levels between the two groups 1 day and 3 days after surgery(P>0.05).The anal function index and Wexner urinary incontinence score in the Lift-plug group were lower than those in the conventional surgery group one month and three months after sur-gery(P<0.05).Three months after surgery,the total effective rate of the Lift-plug group was higher than that of the conventional surgery group(P<0.05).There were no significant differences in the incidence and recurrence of complications 3 months after operation be-tween the two groups(P>0.05).Conclusion Lift-plug surgery for TSAF patients can optimize surgery,reduce neurogenic inflammatory response,alleviate early pain,improve sphincter function,and enhance clinical efficacy,which achieves great safety.
万方数据
维普
