复杂性肛瘘术后肛门失禁风险预测模型的建立及评价

Establishment and evaluation of risk prediction model of anal incontinence after complex anal fistula surgery

摘要:

目的 构建复杂性肛瘘术后并发肛门失禁的风险预测模型并进行效果评价。方法 回顾性分析2020年1月至2021年5月福建中医药大学附属人民医院肛肠科收治的195例复杂性肛瘘患者资料。根据术后肛门失禁症状，将CCFIS评分≥2分划为肛门失禁组（42例），CCFIS评分<2分划为功能正常组（153例）。结合患者一般情况、瘘管性质、肛门直肠压力测定结果、手术方式等变量进行单因素及logistic回归分析。结果 术后肛门失禁发生率为21.54%，CCFIS平均分为（3.40±1.170）分。logistic回归分析结果显示，瘘管类型为括约肌上瘘（OR=1.024，95%CI=0.405~2.585，P=0.025）、既往有1次以上的瘘管手术（OR=16.224，95%CI=3.291~29.977，P=0.001）、低静息压（OR=0.909，95%CI=0.869~0.952，P=0.000）、手术方式为切割挂线术（OR=1.389，95%CI=1.044~1.848，P=0.024）是复杂性肛瘘术后并发肛门失禁的独立危险因素（P<0.05）。根据筛选出的独立危险因素构建预测模型，绘制受试者工作特征（receiver operating characteristic，ROC）曲线，曲线下面积（area under the curve，AUC）为0.879（95%CI=0.818~0.939，P<0.001），提示该模型有较好的预测价值。结论 通过独立危险因素建立的预测模型准确度较高，为临床复杂性肛瘘治疗方案的制订提供较好的参考依据。

Abstract:

Objective To establish a risk prediction model of anal incontinence after complex anal fistula surgery and evaluate its effect.Methods The data of 195 patients with complex anal fistula admitted to the Anorectal Department of The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January 2020 to May 2021 were analyzed retrospectively. According to the symptoms of postoperative anal incontinence，the patients with CCFIS score ≥ 2 points were divided into anal incontinence group （42 cases），and the patients with CCFIS score<2 points were divided into normal function group（153 cases）. Univariate and logistic regression analysis was carried out in combination with the general situation of patients， fistula nature， anorectal manometry measurement results，surgical methods and other variables.Results The incidence of postoperative anal incontinence was 21.54%，and the average score of CCFIS was 3.40±1.170. Logistic regression analysis showed that the fistula type was supra-sphincter fistula（OR=1.024，95%CI=0.405–2.585，P=0.025），previous anal fistula surgery > 1 time in the past（OR=16.224，95%CI=3.291–29.977，P=0.001），low resting pressure（OR=0.909，95%CI=0.869–0.952，P=0.000），and the operation method was cutting seton（OR=1.389，95%CI=1.044–1.848，P=0.024），which were independent risk factors of the anal incontinence after complex anal fistula surgery（P<0.05）. According to the screened independent risk factors，the prediction model was constructed and the ROC curve was drawn. The area under the curve（AUC） was 0.879（95%CI=0.818-0.939，P<0.001），suggesting a good prediction value of the model.Conclusion The prediction model established by independent risk factors has high accuracy， and provides a good reference for the formulation of clinical treatment plan for complex anal fistula.