视频辅助治疗肛瘘系统治疗ParksⅡ型肛瘘的疗效评价  

The therapeutic evaluation of video-assisted anal fistula treatment for Parks Ⅱ anal fistula

作　　者：张玉茹[1] 张秀[1] 黄斌[1] 刘连成[1] 任春成 王敏[1] 赵团结[1] 张志亮[1] 韩旭 Zhang Yuru;Zhang Xiu;Huang Bin;Liu Liancheng;Ren Chuncheng;Wang Min;Zhao Tuanjie;Zhang Zhiliang;Han Xu(Department of Anorectal Surgery,Beifing Hospital of Coloproctology,Beijing 100011,China)

机构地区：[1]北京市肛肠医院(北京市二龙路医院)肛肠外科,北京100011

出　　处：《中华普通外科杂志》2018年第8期658-661,共4页Chinese Journal of General Surgery

基　　金：北京市科技计划课题资助项目（Z151100003915106）;北京市西城区优秀人才培养资助项目（20180008）

摘　　要：目的对比分析视频辅助治疗肛瘘与肛瘘切开挂线术治疗ParksⅡ型肛瘘的临床疗效和安全性。方法2015年6月至2017年6月北京市肛肠医院采用视频辅助治疗ParksII型肛瘘患者40例，采用肛瘘切开挂线术治疗40例，对两组疗效加以比较。结果两组患者的疗效、术后并发症发生率（尿潴留、并发伤口边缘水肿、出血）和术后6个月复发率相比差异均无统计学意义（90％比95％,χ^2=0．722，P=0．697；5％比8％，χ2=0．213，P=1．000；2％比8％，χ^2=1．053，P=0．615；0比5％χ^2=2．051，P=0．494；10％比5％，χ^2=0．721，P=0．675）。与对照组相比，观察组术后第1天和术后1周疼痛较轻[（1．9±0．6）分比（3．7±1．0）分，t=9．438，P=0．001；（0．9±0．7）分比（1．9±0．8）分，t=6．269，P=0．001]、住院时间短[（8．4±1．3）d比（9．2±2．2）d，t=2．030，P=0．047]、创面怠合快[（27±8）d比（38±6）d，t=7．328，P=0．001]、Jorge-Wexner便失禁评分t（0．5±0．7）分比（1．2±1．3）分，t=2．951，P=0．005]以及控便失禁严重度指数评分[（1．1±1．6）分比（5．1±3．2）分．t=7．097，P=0．001]低，差异均有统计学意义。结论视频辅助治疗肛瘘创伤小、恢复快、不损伤肛门括约肌，安全有效。Objective To evaluate video-assisted anal fistula treatment （VAAFT） for Parks type Ⅱ anal fistula. Methods 40 Parks type Ⅱ anal fistula patients underwent VAAFT procedure from June 2015 to June 2017. Results were compared with 40 cases treated by incision and thread drawing. Results There was no significant difference between the two groups for curative effect, postoperative urinary retention, wound edema, bleeding and recurrence rate after 6 months of operation （90% vs. 95% ,X^2 = 0. 722, P = 0.697; 5% vs. 8%,χ^2=0.213, P=1.0; 2% vs. 8%,χ^2 =1.053, P=0.615; 0 vs. 5%,χ^2 =2.051, P = 0. 494; 10% vs. 5% ,χ^2 = 0. 721, P = 0. 675）. Pain on first day and one week after operation in the VAAFT was less E（1.9±0.6） vs. （3.7±1.0）, t=9.438, P=0.001; （0.9±0.7） vs. （1.9±0.8）, t=6.269, P=0.001, hospital stay was shorter E8.4± 1.3） d vs. （9.2 ±2.2） d, t =2.030, P= 0. 047 ], wound healing was faster [ （27 ± 8） d vs. （38 ±6） d, t =7. 328, P =0. 001 ]. The Jorge-Wexner incontinence score [ （0. 5 ± O. 7 ） vs. （ 1.2 ± 1.3 ） , t = 2. 951, P = 0. 005 ] and the fecal incontinence severity index [（1.1±1.6） vs. （5.1 ±3.2）, t =7.097, P=0.001] were lower in patients receiving VAAFT procedure. Conclusion Video-assisted anal fistula treatment is a safe and effective surgical method with the advantages of less trauma, and pain, quicker recovery and no damage to the anal sphineter.

关 键 词：直肠瘘 外科手术 微创性 

分 类 号：R657.16[医药卫生—外科学]