摘要
目的探讨瘘管潜行剥离并括约肌游离丝线牵引术治疗高位肛瘘的效果。方法纳入2018年4月至2019年6月本院收治的102例高位肛瘘患者为研究对象,按随机数字表法分为观察组与对照组,每组各51例。观察组采用瘘管潜行剥离并括约肌游离丝线牵引术治疗,对照组采用肛瘘切开挂线引流术治疗。记录两组疗效、术后VAS评分、创面愈合时间、肛门失禁评分、肛管压力检测结果、瘢痕纵径、瘢痕面积,以及复发情况。结果两组治愈率均为100%。两组术后第1、7天VAS评分比较,差异均无统计学意义(均P>0.05);术后第3天,观察组VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组创面愈合时间短于对照组(P<0.05)。两组术前Wexner肛门失禁评分比较,差异无统计学意义(P>0.05);术后1、3个月,观察组Wexner肛门失禁评分均低于对照组(均P<0.05)。术前,两组肛管静息压与肛管最大收缩压比较,差异均无统计学意义(均P>0.05);术后1个月,观察组肛管静息压与肛管最大收缩压均高于对照组(均P<0.05)。两组瘢痕纵径比较差异无统计学意义(P>0.05);观察组瘢痕面积小于对照组(P<0.05)。随访半年,两组复发率比较差异无统计学意义(P>0.05)。结论瘘管潜行剥离并括约肌游离丝线牵引术治疗高位肛瘘疗效确切,较肛瘘切开挂线引流术具有减轻疼痛、缩短创面愈合时间、减小瘢痕、保护肛门功能的优势。
Objectives To investigate the effect of fistula stripping and sphincter mobilization-thread traction for high anal fis⁃tula.Methods One hundred and two patients with high anal fistula were recruited from our hospital between April 2018 and June 2019.Patients were randomly assigned to treatment group and control group,with 51 patients in each group.Patients in the treatment group received fistula stripping and sphincter mobilization-thread traction,and those in the control group received fistulotomy and seton placement.The followings were compared between the two groups:cure rate,visual analog scale(VAS)score of postoperative pain,wound healing time,Wexner incontinence score,anal manometry,scar longitudinal diameter,scar ar⁃ea,and recurrence rate.Results The cure rate was 100%in both groups.Pain VAS did not differ between the two groups on the 1st and 7th day after surgery(P>0.05)but it was significantly lower in the treatment group on the 3rd day(P<0.05).The wound healing time was significantly shorter in the treatment group(P<0.05).The two groups did not differ in Wexner inconti⁃nence score before surgery(P>0.05),but the treatment group had significantly lower score at 1 and 3 months after surgery(P<0.05).Anal resting pressure and maximum systolic pressure were similar between the two groups before surgery(P>0.05)and were significantly higher in the treatment group at 1 month after surgery(P<0.05).The scar longitudinal diameter did not differ significantly between the two groups(P>0.05),but the treatment group had a significantly smaller scar area(P<0.05).Patients were followed up for 6 months.The recurrence rate was similar between the two groups(P>0.05).Conclusion Fistula stripping and sphincter mobilizaiton-thread traction was effective in treating high anal fistula.Compared with fistulotomy and seton place⁃ment,it was associated with less pain,shorter wound healing time,and smaller scar area.It also protected anal function.
作者
李敏
李天然
徐小波
刘肖
Li Min;Li Tianran;Xu Xiaobo;Liu Xiao(Department of Anorectal Diseases,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)
出处
《结直肠肛门外科》
2020年第6期734-738,共5页
Journal of Colorectal & Anal Surgery
基金
四川省中医药管理局科学技术研究专项项目(2018LC019)。
关键词
高位肛瘘
瘘管剥离并括约肌游离丝线牵引术
肛瘘切开挂线引流术
临床疗效
high anal fistula
fistula stripping and sphincter mobilization-thread traction
fistulotomy and seton placement
clini⁃cal efficacy
