| 引用本文:姚一博，王琛，梁宏涛，李锋，曹永清，陆金根.基于影像学和临床体征的隧道式拖线术治疗复杂性肛瘘预后因素COX回归分析[J].世界中医药,2016,(06):. |
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| 基于影像学和临床体征的隧道式拖线术治疗复杂性肛瘘预后因素COX回归分析 |
| COX Regression Analysis of Prognostic Factors Tunnel Thread-drawing Therapy for Complex Anal Fistula |
| 投稿时间：2016-04-11 |
| DOI：10.3969/j.issn.1673-7202.2016.06.024 |
| 中文关键词: 隧道式拖线术 复杂性肛瘘 手术疗效 预后因素 COX回归分析 |
| English Keywords:Tunnel thread-drawing therapy Complex anal fistula Surgical outcome Prognostic factors COX regression analysis |
| 基金项目:上海市卫生局面上项目（编号：20134069）；上海市肛肠病中医临床研究基地建设项目三年行动计划（编号：ZY3-LCPT-1-1002）；海派中医流派（顾氏外科）传承研究基地建设项目（编号：ZY3-CCCX-1-1004资助) |
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| 中文摘要: |
| 目的：通过回顾性研究肛周核磁共振及复杂性肛瘘的临床体征，对比隧道式拖线术治疗复杂性肛瘘一次性治愈和复发病例特点，通过COX模型进行单因素分析影响隧道式拖线术手术预后的因素,提高术前评价的准确性，减少术后不可逆的肛门功能损伤以及术后复发率。方法：纳入2011年1月至2013年12月于上海中医药大学附属龙华医院肛肠外科行复杂性肛瘘隧道式拖线术患者217例。对比一次性治愈组和复发组患者在人口学基本资料、临床体征、肛周核磁共振提取数据的差异，并采用COX回归模型分析影响隧道式拖线手术预后的因素。临床资料采用单因素分析和多因素分析相结合的方法：对于非正态分布的数据，2组数据的总体分布比较采用Mann-Whitney检验。结果：根据单因素分析2组之间的差异，将人口基本资料、临床体征及肛周核磁共振提取数据通过COX模型进行单因素分析，发现与术后复发相关的因素包括BMI、炎症感染肛周肌肉的数量、肛周分泌物量、以及内口位置。结论：经单因素研究分析发现：瘘管位于6-9象限、瘘管延伸范围大于两个象限、炎症波及内括约肌、耻骨直肠肌、肛提肌或坐骨直肠间隙、直肠后深间隙的括约肌间、括约肌上、括约肌外的瘘管，术后容易复发。 |
| English Summary: |
| To establish the predictive model of tunnel thread-drawing therapy of complex anal fistula surgery through a retrospective study by comparing the difference of the cases with and without recurrence,so as to improve the accuracy of the preoperative evaluation,and to reduce both the recurrence rate and postoperative irreversible injury.Methods:During January 2011 and December 2013 at the Shanghai University of Traditional Chinese Medicine,Longhua Hospital,217 patients received the tunnel thread-drawing therapy of complex anal fistulas.Comparisons were performed between the recurrence group and non-recurrence group on demographic,clinical signs and manifestations,MRI diagnostic data,differences in postoperative care.COX regression analysis of factors affecting patients’ recurrence was used for the prediction model to forecast the outcome.The validation group was used to validate the prediction model.Univariate analysis and multivariate analysis methods were combined on the clinical data.The Mann-Whitney test was used on non-normally distributed data.Results:Key findings from the analysis suggested that the recurrence was related with BMI,affected anal muscles,anal secreta and the internal opening quadrant.Conclusion:Through single factor analysis,it was found that when the intersphincteric,sphincter and extrasphincteric fistula occurred in the 6-9 quadrant,the range covered more than two quadrants,or the inflammation covered more than three types of muscle (the inner sphincter,the puborectalis and the levator ani muscle) or the gap (the ischiorectal space and the retrorectal space),it had the possibility to affect prognosis. |
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