Parks改良虚挂线配合TROPIS术治疗高位括约肌间肛瘘的疗效观察

doi:10.3969/j.issn.1006-6233.2025.01.024

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摘要 目的: 探究Parks改良虚挂线配合经肛括约肌间切开(TROPIS)术在高位括约肌间肛瘘患者中的应用效果。方法: 选取2021年2月至2023年10月901医院收治的高位括约肌间肛瘘患者92例,随机数字表法分为两组,每组46例,对照组采取切开挂线术,观察组采取Parks改良虚挂线配合TROPIS术治疗。比较两组手术相关指标、疼痛及创面愈合、并发症、复发率及手术前后炎症应激[白介素-1(IL-1)、髓过氧化物酶(MPO)、白介素-6(IL-6)]、括约肌功能及创面局部微环境。结果: 观察组术中出血量为(8.32±2.17)mL,低于对照组的(21.46±4.76)mL,手术及水肿消退、创面渗出物消失、创面完全愈合等时间分别为(35.57±6.59)min、(5.12±1.38)d、(6.24±1.96)d、(16.52±2.74)d均低于对照组的(48.26±8.17)min、(6.53±1.47)d、(7.38±1.63)d、(18.27±3.51)d,(P<0.05);术后1d、3d、7d、14d观察组疼痛评分为(4.14±0.63)d、(3.02±0.51)d、(1.84±0.53)d、(0.82±0.29)d,低于对照组的(5.35±0.56)d、(5.35±0.56)d、(3.16±0.87)d、(1.97±0.35)d,(P<0.05);术后7d、14d,观察组创面愈合优于对照组(P<0.05);术后1d、3d、7d观察组血清MPO、IL-1、IL-6水平低于对照组(P<0.05);术后7d观察组厚壁菌门比例为(86.35±3.69)%,高于对照组的(74.18±4.54)%,变形菌门、放线菌门比例为(7.25±1.00)%、(1.87±0.24)%,低于对照组的(16.37±1.36)%、(2.65±0.32)%,(P<0.05);术后1、3个月观察组Wexner失禁评分低于对照组,肛管静息压、肛管最大收缩压高于对照组(P<0.05);观察组并发症发生率8.70%低于对照组23.91%(P<0.05);随访6个月,观察组复发率2.17%与对照组10.87%相比,无显著差异(P>0.05)。结论: Parks改良虚挂线配合TROPIS术可减轻患者括约肌损伤,降低炎症应激及并发症风险,维持创面局部微环境,加速术后康复进程。

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	张雁
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关键词 ：括约肌间肛瘘, Parks改良虚挂线, 康复进程, 经肛括约肌间切开术, 创面愈合

Abstract：Objective: To investigate the effect of Parks modified virtual hanging line combined with transanal sphincterotomy (TROPIS) in patients with high sphincteroanal fistula. Methods: A total of 92 patients with high intersphincter anal fistula admitted to 901 Hospital from February 2021 to October 2023 were selected and divided into two groups, with 46 cases in each group by random number table method. The control group was treated with incision and hanging line, and the observation group was treated with Parks modified virtual hanging line and TROPIS. The postoperative indexes, pain and wound healing, complications, recurrence rate, inflammatory stress [interleukin-1 (IL-1), myeloperoxidase (MPO), interleukin-6 (IL-6)], sphincter function and local wound microenvironment were compared between the two groups. Results: The intraoperative bleeding volume in the observation group was (8.32±2.17) mL, which was lower than that in the control group (21.46±4.76) mL. The time for surgery and edema resolution, wound exudate disappearance, and complete wound healing in the observation group were (35.57±6.59) min, (5.12±1.38) d, (6.24±1.96) d, and (16.52±2.74) d, respectively, which were lower than in the control group (48.26±8.17) min, (6.53±1.47) d, (7.38±1.63) d, and (18.27±3.51) d, respectively, with a P value lower than 0.05. At 1 day, 3 days, 7 days, and 14 days after surgery, the pain score in the observation group was (4.14±0.63)d, (3.02±0.51)d, (1.84±0.53)d, and (0.82±0.29)d, which was lower than the control group at (5.35±0.56)d, (5.35±0.56)d, (3.16±0.87)d, and (1.97±0.35)d, with a P value lower than 0.05. The wound healing in the observation group was better than in the control group at 7 and 14 days after operation (P<0.05). The levels of serum MPO, IL-1 and IL-6 in the observation group were lower than in the control group at 1, 3 and 7 days after surgery (P<0.05). After 7 days of surgery, the proportion of Firmicutes in the observation group was (86.35±3.69)%, higher than that of the control group at(74.18±4.54)%. The proportion of Proteobacteria and Actinobacteria was (7.25±1.00)% and (1.87±0.24)%, respectively, lower than the control group at (16.37±1.36)% and (2.65±0.32)%, respectively, (P<0.05). The Wexner incontinence score of the observation group was lower than that of the control group, and the resting pressure and maximum systolic pressure of the anal canal were higher than those of the control group (P<0.05). The complication rate of observation group was 8.70%, lower than that of control group (23.91%) (P<0.05). After 6 months of follow-up, the recurrence rate of observation group was 2.17% compared with 10.87% in control group, and there was no significant difference (P>0.05). Conclusion: Parks modified virtual hanging line combined with TROPIS can alleviate sphincter injury, reduce inflammatory stress and complication risk, maintain local wound microenvironment, and accelerate postoperative rehabilitation.

Key words： Intersphincter anal fistula Parks modified virtual hanging line Rehabilitation process Transanal intersphincterotomy Wound healing

基金资助:安徽省卫生厅医药科研计划项目,(编号:11367KJ20210326)

通讯作者: 宇汝翠

引用本文:

张雁, 梁力川, 何芳, 宇汝翠. Parks改良虚挂线配合TROPIS术治疗高位括约肌间肛瘘的疗效观察[J]. 河北医学, 2025, 31(1): 132-138.
ZHANG Yan, LIANG Lichuan, HE Fang, et al. Curative Effect of Parks Modified Virtual Hanging Line Combined with TROPIS in the Treatment of High Intersphincter Anal Fistula. HeBei Med, 2025, 31(1): 132-138.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.01.024 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I1/132

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