摘要
目的探讨改良经肛括约肌间切开术(括约肌间入路)治疗高位肛瘘的临床疗效。方法回顾性分析南京中医药大学附属南京中医院肛肠中心2019年3月至2020年12月收治的66例高位肛瘘患者的临床资料,患者均接受改良经肛括约肌间切开术(括约肌间入路)治疗。记录临床疗效(手术治愈情况),手术前后的Wexner肛门失禁评分及术后并发症发生情况。结果术后对患者进行了6~28个月的随访(中位时间为18.5个月)。66例患者中,单次手术后治愈率为93.9%(62/66),其中伴发脓肿16例,无脓肿46例。4例瘘管未愈合的患者进行了再次手术,且仍选择改良经肛括约肌间切开术(括约肌间入路),均治愈。35例(53%)患者既往无肛周脓肿/肛瘘手术史,且单次手术后治愈,手术前后的Wexner肛门失禁评分比较差异无统计学意义(P>0.05)。所有入组患者的手术前后的Wexner肛门失禁评分比较差异无统计学意义(P>0.05)。66例患者中,单次手术后有12例(18.2%)出现术后尿潴留,无术后出血患者,无切口感染患者。仅接受改良经肛括约肌间切开术(括约肌间入路)治疗的患者术后未出现肛门“锁眼”畸形。结论对经肛括约肌间切开术进行改良,从括约肌间入路治疗高位肛瘘简化了手术操作,且手术治愈率较高,可最大程度保护肛门功能,减少术后出血。
Objectives To investigate the clinical efficacy of modified transanal opening of intersphincteric space(TROPIS)with intersphincteric approach for high anal fistula.Methods This was a retrospective analysis of 66 patients with high anal fistula treated at the National Center for Colorectal Disease Treatment,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing Univer⁃sity of Chinese Medicine,between March 2019 and December 2020.All patients were treated with modified TROPIS with inter⁃sphincteric approach.Clinical efficacy,pre-and post-operative Wexner anal incontinence score,and complications were recorded.Results Patients were followed up postoperatively for 6 to 28 months(median 18.5 months).Of the 66 patients,the cure rate af⁃ter single surgery was 93.9%(62/66),among which 16 patients had abscess and 46 did not have abscess.For the four patients in whom the fistula was not healed,all received repeated modified TROPIS with intersphincteric approach and were all cured.Thirtyfive(53%)patients did not have a history of abscess or fistula surgery and were considered cured after single surgery;among these 35 patients,no significant differences between pre-and post-operative Wexner anal incontinence scores(P>0.05)were found.Among the 66 patients,there were also no significant differences between pre-and post-operative Wexner anal inconti⁃nence score(P>0.05).Among the 66 patients,12(18.2%)had postoperative urinary retention after single surgery;no patients had postoperative bleeding or incision infection.No patients who received only modified TROPIS with intersphincteric approach had keyhole-like cicatricial deformity.Conclusion The intersphincteric approach modifies and simplifies the procedure of TROPIS with high cure rate for high anal fistula.It also maximizes the chances of preserving anal function and reduces the risk of post⁃operative bleeding.
作者
侯毅
郑雪平
谭妍妍
周峰
皇甫少华
徐大超
王燕
Hou Yi;Zheng Xueping;Tan Yanyan;Zhou Feng;Huangfu Shaohua;Xu Dachao;Wang Yan(National Center for Colorectal Disease Treatment,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chi-nese Medicine,Nanjing 210012,Jiangsu,China;Nanjing University of Chinese Medicine,Nanjing 210022,Jiangsu,China)
出处
《结直肠肛门外科》
2022年第5期469-473,共5页
Journal of Colorectal & Anal Surgery
基金
南京市“十三五”规划名中医工作室建设项目(ZXP-2019-NJ)。
关键词
高位肛瘘
改良经肛括约肌间切开术
治愈率
肛门功能
并发症
high anal fistula
modified transanal opening of intersphincteric space
cure rate
anal function
complication
