低位肛瘘的术式选择及疗效分析  

Surgical method selection for low anal fistula and effect analysis

作　　者：王锋[1] 范发明[1] 

机构地区：[1]淮安市第一人民医院一分院普外科,江苏淮安223001

出　　处：《西南国防医药》2017年第12期1313-1315,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨低位肛瘘不同手术方法的治疗效果。方法回顾性分析124例低位肛瘘患者资料,依据术式不同,分为肛瘘切开术组(n=29)、肛瘘切除术组(n=24)、挂线术组(n=22)、部分管道缝合内口引流术组(n=19)、保留内括约肌瘘剔除术组(n=18)和内括约肌瘘管切除缝合术(n=12)组,比较其疗效。结果肛瘘切开术组治疗总有效率100%,肛瘘切除术组95.83%,挂线术组95.45%,部分管道缝合内口引流术组100%,保留内括约肌瘘剔除术组100%,内括约肌瘘切除缝合术组100%,各组差异不显著(P>0.05);肛瘘切除术组NRS评分、中度以上疼痛率显著高于其他各组(P<0.05);肛瘘切开术和挂线术组2 w内愈合率显著低于其各组(P<0.05);随访3~12个月,术后缝合创面感染8例,尿潴留4例,水肿5例,经处理后并发症消失;12例术后肛瘘复发,经二次手术后治愈。各组术后并发症率和复发率比较,均无统计学差异(P>0.05)。结论不同手术方式治疗低位肛瘘,均有显著疗效,应依据患者病情和肛瘘特点,选择合适术式。Objective To explore the effects of different surgical methods in the treatment of low anal fistula. Methods The data of 124 patients with low anal fistula were analyzed retrospectively and divided, according to different surgical methods, into an anal fistula sphincterotomy group（n=29）, an anal fistulectomy group（n=24）, a thread-drawing group（n=22）, a group by drainage of internal drainage by partial suture（n=19）, a group by fistula excision with internal anal sphincter retained（n =18） and a group by internal sphincter fistula resection and suture（n=12）. The effects among these groups were compared. Results The overall response rate（ORR） was 100% in the anal fistula sphincterotomy group, and 95.83% in the anal fistulectomy group, 95.45% in the threaddrawing group, 100% in the group by drainage of internal drainage by partial suture, 100% in the group by fistula excision with internal anal sphincter retained and 100% in the group by internal sphincter fistula resection and suture, showing no significant difference（P 〈 0.05）; the NRS scores and moderate to severe pain rate in the anal fistulectomy group were significantly higher than those in other groups（P 〈 0.05）; the healing rates within two weeks in the anal fistula sphincterotomy group and thread-drawing group was much lower than those in other groups（P 〈 0.05）; during 3-12-month follow-up visits, there were eight cases of postoperative suture wound infection, four cases of urinary retention, and five cases of edema, but such complications disappeared after treatment;12 patients had anal fistula recurrence after the operation and healed after reoperation. There was no statistical difference in the incidence of postoperative complications and recurrence rate among these groups（P 〉 0.05）. Conclusion Different surgical methods have significant effects in the treatment of low anal fistula and should be selected according to patients＇ condition and the characteristics of anal fistula.

关 键 词：低位肛瘘 术式 选择 疗效 

分 类 号：R656[医药卫生—外科学]