摘要
目的:探讨三种手术对高位复杂肛瘘的临床应用价值差异.方法:随机数字表法将75例高位复杂肛瘘患者分为A、B、C三组各25例.其中A组予以主管切开挂线支管旷置引流术;B组予以低位挂线高位扩创引流术;C组予以低位切开高位挂线术.比较三组患者临床治愈率、相关并发症发生率及术后6个月复发率差异,比较其围术期指标(手术时间、术中失血量、创面大小、创口愈合时间、总住院时间)、术后疼痛情况[休斯顿疼痛情况调查表(HPOI)]及肛门功能[肛门失禁评分(Wexner)]、肛管压力指标[肛管静息压(ARP)、肛管最大收缩压(AMCP)、肛管最长收缩时间(ALCT)]评估结果差异.结果:三组患者近期治愈率、术后6个月复发率及手术时间、术中失血量比较均无显著性.A、B组术后相关并发症发生率、创面大小、创面愈合时间及总住院时间均明显低于C组,但A、B两组上述指标比较均无显著性.术后第1d、第7d时,A、B组HPOI评分结果均明显低于C组,但A、B两组比较无显著性.术后7d、术后6个月时,三组除ALCT检测结果未见显著性差异外,A、B组Wexner肛门失禁评分结果均明显低于C组,ARP、AMCP检测结果则明显高于C组,差异均有显著性,但A、B两组比较无显著性.结论:主管切开挂线支管旷置引流术及低位挂线高位扩创引流术在高位复杂肛瘘临床治疗中的应用价值均较低位切开高位挂线术突出,临床可根据患者实际情况选择最佳术式,以获得更理想的治疗效果.
Objective To investigate the clinical effect of three kinds of surgeries for treating high complex anal fistula.Methods 75 cases of patients with high complex anal fistula were divided into group A,group B and group C by random number table method with 25 cases in each group.Group A were treated with main fistula dissected and seton branch exclusion drainage while group B were treated with low seton and high opening drainage,and group C were treated with low incision and high seton.The clinical cure rate,the incidence of related complications and recurrence rate were compared among the three groups.The perioperative indicators(surgical time,intraoperative blood loss,wound size,wound healing time,total hospitalization time),postoperative pain[Houston Pain Outcome Instrument(HPOI)],anal function[anal incontinence score(Wexner)]and anal canal pressure indexes[anal resting pressure(ARP),anal maximal contraction pressure(AMCP),anal longest contraction time(ALCT)]were also compared.Result There was no significant difference among the three groups in the short-term cure rate,the recurrence rate,surgical time and intraoperative blood loss.The incidence of postoperative complications,wound size,wound healing time and total hospitalization time in group A and group B were significantly lower,smaller and shorter than those in group C,but there was no significant difference between group A and group B.1 day and 7 days after surgery,HPOI scores of group A and group B were significantly lower than those of group C but there was no significant difference between group A and group B.7 days and 6 months after surgery,there was no significant difference in ALCT among three groups.Wexner anal incontinence scores of group A and group B were significantly lower than those of group C,ARP and AMCP were significantly higher than those in group C but there was no significant difference between group A and group B.Conclusion Main fistula dissected with seton branch exclusion drainage and low seton with high opening drainage are more effec
作者
郭涛
Guo Tao(General surgery Department of Anhui Huaibei Coal Miners General Hospital,Huaibei 235000,China)
出处
《湖南师范大学学报（医学版）》
2019年第4期127-130,共4页
Journal of Hunan Normal University(Medical Sciences)
关键词
术式
高位复杂肛瘘
临床疗效
预后
surgery
high complex anal fistula
clinical curative effect
prognosis
