脱细胞异体真皮基质填塞修复高位肛瘘  

Allogenic acellular extracellular matrix repairs high anal fistula

作　　者：王健诚[1,2] 王炜[1,2] 张科[1,2] 邹世镇[1,2] 

机构地区：[1]广西医科大学第四附属医院 [2]柳州市工人医院普通外科,广西壮族自治区柳州市545005

出　　处：《中国组织工程研究》2014年第34期5497-5502,共6页Chinese Journal of Tissue Engineering Research

基　　金：广西省卫生厅2014年度自筹科研项目(Z2014381)~~

摘　　要：背景:治疗高位肛瘘的方法有瘘管剔除、切开挂线、选择性黏膜瓣推移、生物蛋白胶封堵、括约肌间瘘管结扎等,大都存在创面愈合间长、一次成功率较低、复发率偏高的不足,术后并发症发生率高。目的:观察应用脱细胞异体真皮基质治疗高位肛瘘的临床疗效,探讨治疗高位肛瘘的微创治疗新方法。方法:选择100例高位肛瘘患者,根据患者意愿分2组治疗,治疗组采用脱细胞异体真皮基质填塞治疗,对照组采用传统的肛瘘低位切开并高位挂线治疗,比较两组手术时间、术中出血量、术后目测类比评分、术后疼痛持续时间、肛门失禁严重程度评分、创面愈合时间、一期手术成功率、治愈率及复发率。结果与结论:治疗组手术时间、术中出血量、创面愈合时间、术后目测类比评分、术后疼痛持续时间、肛门失禁严重程度评分均低于对照组(P<0.05),一期手术成功率及治愈率高于对照组(P<0.05),两组复发率比较差异无显著性意义。表明脱细胞异体真皮基质填塞修复高位肛瘘具有创伤小、恢复快、疗程短、治愈率高和不损害肛门功能及外观的优点。BACKGROUND：Treatment methods for high anal fistula include fistula removal, incision and thread drawing, selective mucosal flap displacement, fibrin glue closure, fistula liagtion between sphincter, most of which show many advantages, including long-term healing, a low success rate, high recurrence rate, and high postoperative complication rate. OBJECTIVE：To observe the clinical effect of acelular extracelular matrix in the treatment of high anal fistula, and to explore a minimaly invasive treatment for high anal fistula. METHODS： Totaly 100 cases of high anal fistula were randomly divided into treatment group and control group, 50 cases in each group. Treatment group were treated with alogenic acelular extracelular matrix, and control group were treated with traditional low incision with high thread-drawing. Then, we observed and compared the operation time, bleeding volume, postoperative pain score （visual analog scale score）, postoperative pain duration, anal incontinence severity score （Wexner score）, wound healing time, one-stage success rate, cure rate, recurrence rate. RESULTS AND CONCLUSION： Compared with the control group, the treatment group showed lower scores in the operation time, bleeding volume, wound healing time, visual analog scale score, postoperative pain duration, and anal incontinence severity score （P 〈 0.05）, but higher scores in one-stage success rate and cure rate （P 〈 0.05）. There was no difference in the recurrence rate between the two groups. These findings indicate that the alogenic acelular extracelular matrix for treatment of high anal fistula exhibits smal trauma, quick recovery, short course of treatment, high cure rate and has no damage to the anal function and appearance.

关 键 词：生物材料 材料相容性 脱细胞真皮基质 高位肛瘘 低位切开 对比研究 

分 类 号：R318[医药卫生—生物医学工程]