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

Abstract

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

CLC Number:

R615

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.

Figures/Tables 8

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References 24

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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

Feasibility of modified LIFT guided by magnetic resonance imaging in the treatment of deep anorectal abscess

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临床特征	OR	95%CI	P值
年龄< 60岁	0.909	0.210 ~ 3.930	0.898
性别	0.923	0.179 ~ 4.330	0.919
BMI < 24 kg/m²	1.917	0.442 ~ 8.310	0.380
吸烟	0.438	0.080 ~ 2.400	0.333
糖尿病	2.250	0.181 ~ 27.952	0.519
脓肿部位	0.825	0.084 ~ 8.080	0.869
合并瘘管	3.500	0.642 ~ 19.068	0.132
内口明确	2.545	0.466 ~ 13.910	0.270

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组别	例数	愈合例数	愈合率/%	χ²值	P值
研究组	47	38	80.9	6.034	0.012
对照组	47	27	57.4