2008-2013年分段开窗旷置+切扩挂线置管术治疗疑难性肛瘘患者的回顾性分析128例  

Segment window exclusion plus cutting seton catheterization for treatment of complex anal fistula: Analysis of 128 cases

作　　者：王东宏[1] 何永恒[2] 胡响当[2] 赵鹏飞[2] 

机构地区：[1]新疆医科大学附属中医医院肛肠科,新疆维吾尔自治区乌鲁木齐市830000 [2]湖南中医药大学附二院肛肠科,湖南省长沙市410005

出　　处：《世界华人消化杂志》2014年第27期4195-4199,共5页World Chinese Journal of Digestology

基　　金：湖南省教育厅重点基金资助项目;No.08A051~~

摘　　要：目的:探讨分段开窗旷置结合切扩挂线置管术治疗复杂性肛瘘的疗效和安全性.方法:回顾性分析2008-2013年采用本手术治疗的复杂性肛瘘患者128例,术后随访1 mo-1年,对术后主要并发症及复发情况进行分析.结果:住院和随访期内:术后并发症疼痛平均指数(3.24±1.01),出血评分(1.78±0.37),创面愈合时间(32.65 d±12.13 d),挂线脱落时间(17.35 d±2.42 d),控便能力wexner评分(3.26±1.08);术后肛门功能情况及复发情况:污损12例(9.3%)、排气受损5例(3.9%)、排液体便受损2例(1.6%),随访6 mo后上述症状消失;随访期内复发2例(1.6%);肛管直肠压力和直肠感觉和肛门节制功能检测结果:肛门肛门最大静息压、肛管最大收缩压、保留容量、首次漏出量术后1和3及6 mo与术前比较差异具有统计学意义(P<0.05);术后12 mo与术前比较差异无统计学意义(P>0.05).结论:术前详细评估、完善相关检查及行肛门功能检测,术中采用本术式最大限度地减少括约肌的损伤,术后加强肛门功能锻炼是防止肛瘘复发和减少术后并发症的关键因素,本术式治疗复杂性肛瘘值得进一步推广.AIM： To assess the efficacy and safety of seg- ment window exclusion plus cutting seton catheterization in the treatment of complex anal fistula. METHODS： A retrospective analysis of 128 cases patients who were treated by segment windowexclusion plus cutting seton catheterization for complex anal fistulas over the past five years was performed. Patients were followed for 1 mo to I year. Major postoperative complications and recurrence were recorded.RESULTS： Average pain index was 3.24 ± 1.01. Bleeding score was 1.78 ± 0.37. Wound healing time was 32.65 d ± 12.13 d. Seton off time was 17.35 d _± 2.42 d. Wexner control ability score was 3.26 ± 1.08. There were deface in 12 （9.3%） cases, damaged exhaust in 5 （3.9%） cases and damage to the draining of liquid manure in 5 （1.6%） cases. All these disappeared after 6 mo of follow-up. Recurrence was noted in 2 （1.6%） cases in the follow-up period. Anal maximum static pressure, anal maximum systolic pres- sure, reserve capacity and first leakage dif- fered significantly 1, 3 and 6 mo after surgery compared with before surgery（P 〈 0.05）; how- ever, there was no significant difference be- tween 12 mo after surgery and before surgery （P 〉 0.05）.CONCLUSION： Segment window exclusion plus cutting seton catheterization for complex anal fistula shows satisfactory results. Preoperative detailed assessment, comprehensive functional examination and anal inspection, intraoperative minimization of sphincter injury, and postopera- tive function exercise are key to preventing the recurrence of anal fistula and reducing postop- erative complications.

关 键 词：分段开窗旷置 切扩挂线置管术 复杂性肛瘘 临床分析 

分 类 号：R657.1[医药卫生—外科学]