临床误诊误治

目的探讨影响肛周脓肿或肛瘘术后创面愈合质量的危险因素。方法对肛周脓肿或肛瘘168例的临床资料进行回顾性分析,按术后2周时创面愈合质量分为愈合不良组(38例)与愈合良好组(130例)。比较两组一般资料、合并症、手术情况及术后情况,将比较结果有统计学意义的指标纳入非条件Logistic回归模型进行独立危险因素分析。结果两组年龄、体质量指数(BMI)、合并慢性便秘、合并糖尿病、合并肿瘤、合并慢性胃肠炎、术式选择、并发局部血肿、并发感染、日均坐浴时间及大便性状比较差异均有统计学意义(P<0.05或P<0.01)。非条件Logistic回归模型分析结果显示,BMI<18.5 kg/m²、合并糖尿病、并发感染及大便性状欠佳均是导致肛周脓肿或肛瘘术后创面愈合不良的独立危险因素。结论 BMI<18.5 kg/m²、合并糖尿病、并发感染及大便性状欠佳均是导致肛周脓肿或肛瘘术后创面愈合不良的独立危险因素,临床切口管理应据此采取针对性预防措施,尽可能确保创面良好愈合,改善患者预后。

Objective To explore the risk factors for postoperative wound healing quality in patients with perianal abscess or anal fistula. Methods The clinical data of 168 patients with perianal abscess or anal fistula were retrospectively analyzed. According to the wound healing quality in 2 weeks after operation, the patients were divided into poor healing group(n=38) and good healing group(n=130). The general data, comorbidities, surgical results and postoperative conditions were compared between the two groups, and indicators with statistical significance in the comparison results were included in the unconditional Logistic regression model and analyzed for independent risk factors. Results There were statistically significant differences in the age, body mass index(BMI), complicated chronic constipation, diabetes mellitus(DM), tumor, chronic gastroenteritis, surgical options, concurrent local hematoma rate, concurrent infection rate, average duration of hip bath on a daily basis and stool property between the two groups(P<0.05 or P<0.01). Unconditional Logistic regression model analysis showed that BMI<18.5 kg/m², DM, concurrent infection and poor stool property were independent risk factors for poor postoperative wound healing of perianal abscess or anal fistula(P<0.05). Conclusion BMI<18.5 kg/m², DM, concurrent infection and poor stool property are independent risk factors for poor postoperative wound healing of perianal abscess or anal fistula. It is necessary to take targeted preventive measures in incision management in clinical practice, so as to ensure the good healing of wound and improve the prognosis of patients.