磁共振指引下改良括约肌间瘘管结扎术在肛周深部脓肿治疗中的有效性和安全性

doi:10.3969/j.issn.1006-5725.2025.01.011

摘要/Abstract

摘要：

目的探讨磁共振指引下改良括约肌间瘘管结扎术（modified ligation of intersphincteric fistula tract， modified， LIFT）在肛周深部脓肿治疗中的有效性和安全性。方法回顾性分析2019年9月至2023年6月在武汉市第四医院结直肠肛门外科手术治疗的符合入排标准的肛周深部脓肿患者148例，其中研究组51例采用改良LIFT术，对照组97例行单纯切开引流术。采用倾向评分匹配法获得基线资料平衡的两组患者各47例，共94例患者纳入本研究。比较两组患者的手术时间、住院时间、疼痛指数、术后并发症、肛门功能及愈合率。结果所有94例患者术前磁共振均能发现起源于括约肌间隙的原发病灶；研究组手术时间为（43.75 ± 11.77）min，长于对照组的（28.90 ± 8.67）min，差异有统计学意义（P < 0.05），研究组术后3个月的愈合率为80.9%，高于对照组的57.4%，差异有统计学意义（P < 0.05），研究组中合并瘘管的脓肿患者有最低的愈合率73.1%，但在各临床特征的单因素分析中差异无统计学意义（P > 0.05）；两组在住院时间、术后疼痛指数、术后并发症和手术前后肛门功能方面差异均无统计学意义（P > 0.05）。结论磁共振指引下改良括约肌间瘘管结扎术可有条件地应用于肛周深部脓肿患者的治疗，能提高初次手术的愈合率，不会明显增加术后并发症的发生率，同时可以避免肛门功能的损伤。

关键词: 肛周脓肿, 磁共振, 括约肌间瘘管结扎术, 内口缝扎, 挂线, 倾向评分匹配

Abstract:

Objective To evaluate the efficacy and safety of magnetic resonance?guided modified ligation of the intersphincteric fistula tract in the treatment of deep anorectal abscess. Methods A retrospective study was conducted on 148 patients with deep anorectal abscess treated at our hospital from September 2019 to June 2023， who met the inclusion criteria. Of these， 51 patients in the observation group underwent modified LIFT， while 97 patients in the control group received incision and drainage. Using propensity score matching， 47 patients from each group with balanced baseline characteristics were selected， resulting in a total of 94 patients being included in the analysis. The study compared operation time， hospital stay， pain index， postoperative complications， anal function， and healing rate between the two groups. Results Primary lesions originating in the sphincter space were identified through preoperative magnetic resonance imaging in all 94 patients. The mean operation time for the observation group was （43.75 ± 11.77） minutes， significantly longer than that of the control group at （28.90 ± 8.67） minutes （P < 0.05）. At three months post?surgery， the healing rate in the observation group was 80.9%， which was significantly higher than the 57.4% observed in the control group （P < 0.05）. Among patients with fistulas in the observation group， the healing rate was 73.1%， although this difference was not statistically significant in the univariate analysis of clinical characteristics （P > 0.05）. No significant differences were found between the two groups regarding the length of hospital stay， pain index， postoperative complications， or anal function （all P > 0.05）. Conclusions Modified LIFT guided by MRI can be conditionally applied in the treatment of deep anorectal abscesses. This approach can enhance the initial surgical healing rate without significantly increasing the incidence of postoperative complications， thereby avoiding potential damage to anal function.

Key words: anorectal abscess, magnetic resonance imaging, ligation of intersphincteric fistula tract, closure of internal opening, seton, propensity score matching

中图分类号:

R615

司志龙,王豪,肖飞. 磁共振指引下改良括约肌间瘘管结扎术在肛周深部脓肿治疗中的有效性和安全性[J]. 实用医学杂志, 2025, 41(1): 65-70.

Zhilong SI,Hao WANG,Fei XIAO. Feasibility of modified LIFT guided by magnetic resonance imaging in the treatment of deep anorectal abscess[J]. The Journal of Practical Medicine, 2025, 41(1): 65-70.

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变量	匹配前		t/χ²值	P值	匹配后		t/χ²值	P值
变量	研究组（n = 51）	对照组（n = 97）	t/χ²值	P值	研究组（n = 47）	对照组（n = 47）	t/χ²值	P值
年龄（x ± s）/岁	35.21 ± 14.05	37.88 ± 13.54	-1.567	0.136	34.04 ± 13.03	36.29 ± 14.42	-1.262	0.221
性别			2.342	0.087			0.468	0.324
男	34	52			32	35
女	17	45			15	12
BMI（x ± s）/（kg/m²）	22.70 ± 1.780	24.44 ± 2.103	-2.084	0.043	23.00 ± 2.53	23.72 ± 2.41	-0.974	0.335
吸烟	18	55	6.128	0.013	17	23	1.567	0.211
糖尿病	4	13	1.016	0.234	3	6	1.106	0.243
脓肿部位			0.530	0.467			0.336	0.562
肌间	8	20			6	8
累及肌外	43	77			41	39
合并瘘管	28	28	9.633	0.002	26	24	0.171	0.418

组别	例数	手术时间/min	住院时间/d
研究组	47	43.75 ± 11.77	7.40 ± 2.186
对照组	47	28.90 ± 8.67	6.95 ± 2.089
t值		4.543	0.665
P值		0.000	0.510

组别	例数	术后第1天	术后第3天
研究组	47	5.95 ± 2.012	3.80 ± 2.016
对照组	47	5.65 ± 2.310	3.75 ± 2.129
t值		0.460	0.156
P值		0.648	0.877

组别	例数	尿潴留	术后出血	漏气漏液	χ²值	P值
研究组	47	8	3	0	0.594	0.304
对照组	47	6	2	0

组别	Wexner评分		Z值	P值
组别	术前	术后3个月	Z值	P值
研究组	0（0，1）	0（0，1）	-1.265	0.206
对照组	0（0，1）	0（0，1）	-1.342	0.180
Z值	-1.275	-0.637
P值	0.289	0.602