摘要
目的对比对切松紧高挂术与传统切开挂线术治疗高位复杂性肛瘘的疗效。方法纳入2020年10月至2021年10月在上海中医药大学附属曙光医院肛肠科住院的68例高位复杂性肛瘘患者为研究对象,采用随机数字表法分为试验组(采用对切松紧高挂术,n=34)和对照组(采用传统切开挂线术,n=34)。比较两组创面愈合时间,术后第3、第7天局部症状(创面出血、创面渗液、肛门坠胀、创面疼痛),术后尿潴留发生率,临床疗效及复发率,术前及术后6个月肛门功能【Wexner肛门失禁评分,肛管最大收缩压(AMCP),肛管静息压(ARP)】。结果试验组创面愈合时间短于对照组(P<0.05)。两组术后第3、第7天创面出血评分比较差异均无统计学意义(均P>0.05)。试验组术后第3天创面渗液评分高于对照组,肛门坠胀评分低于对照组(均P<0.05);两组术后第7天创面渗液评分、肛门坠胀评分比较差异均无统计学意义(均P>0.05)。试验组术后第3、第7天创面疼痛评分均低于对照组(均P<0.05)。两组术后尿潴留发生率比较差异无统计学意义(P>0.05)。术后3个月,两组治疗总有效率比较差异无统计学意义(P>0.05)。两组肛瘘治愈后随访6个月,未见复发病例。术前,两组Wexner肛门失禁评分、AMCP、ARP比较差异均无统计学意义(均P>0.05);术后6个月,对照组Wexner肛门失禁评分较术前升高(P<0.05),两组AMCP、ARP均较术前降低(均P<0.05),试验组Wexner肛门失禁评分低于对照组,AMCP高于对照组(均P<0.05)。结论对切松紧高挂术与传统切开挂线术治疗高位复杂性肛瘘的临床疗效及复发率相近,前者有助于缩短创面愈合时间,减轻术后肛门坠胀、创面疼痛,保护肛门功能。
Objectives To compare the effectiveness between contra-incision combined with high loose-tight thread and traditional incision-thread-drawing procedure for treating high complex anal fistula.Methods Sixty-eight patients with high complex anal fistula treated at the Department of Anorectal Diseases,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,between October 2020 and October 2021 were recruited and randomly assigned to the treatment group(n=34,receiving contra-incision combined with high loose-tight thread)and the control group(n=34,receiving traditional incision-thread-drawing procedure).Time to wound healing and local symptoms(wound bleeding,wound oozing,anal distension,and wound pain)were compared between the two groups 3 and 7 days after surgery.The incidence of postoperative urinary retention,clinical effectiveness,recurrence rate,and anal function(Wexner anal incontinence score,anal maximum contraction pressure,and anal resting pressure)before and 6 months after surgery were also compared between the two groups.Results Time to wound healing was significantly shorter in the treatment group than in the control group(P<0.05).Scores of wound bleeding 3 and 7 days after surgery did not differ significantly between the two groups(P>0.05).The score of wound oozing at 3 days after surgery was significantly higher,and the score of anal distention at 3 days after surgery was significantly lower in the treatment group than in the control group(P<0.05).Scores of wound oozing and anal distention at 7 days after surgery did not differ significantly between the two groups(P>0.05).Scores of wound pain 3 and 7 days after surgery were significantly lower in the treatment group than in the control group(P<0.05).The incidence of postoperative urinary retention did not differ significantly between the two groups(P>0.05).At 3 months after surgery,the overall effectiveness rate did not differ significantly between the two groups(P>0.05).Patients were followed for 6 months after anal fistula w
作者
彭珏
彭云花
刘肃志
陈天
方臣阳
杨巍
Peng Jue;Peng Yunhua;Liu Suzhi;Chen Tian;Fang Chenyang;Yang Wei(Department of Anorectal Diseases,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200120,China)
出处
《结直肠肛门外科》
2022年第6期577-582,共6页
Journal of Colorectal & Anal Surgery
基金
上海市重大临床研究项目(SHDC2020CR2007A)
上海市卫生健康委员会科研课题(20204Y0180)
上海市临床重点专科项目(SHSLCZDZK04302)。
关键词
高位复杂性肛瘘
对切松紧高挂术
传统切开挂线术
high complex anal fistula
contra-incision combined with high loose-tight thread
traditional incision-thread-drawing procedure
