保留括约肌瘘管潜剥术治疗复杂性肛瘘的疗效观察  

作　　者：洪中华[1] 陈会林[1] 钦梦婷 陈宏美[1] 王启[1] 尹和宅[1] 

机构地区：[1]浙江省嘉兴市中医医院,314001

出　　处：《浙江临床医学》2021年第5期697-699,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省中医药科技计划项目(2020ZB256);浙江省嘉兴市科技计划项目(2020AD30015、2018AD32146、2014AY21041);浙江省嘉兴卫生健康实用新技术和适宜技术培育推广项目(2018-TP-10)。

摘　　要：目的观察保留括约肌瘘管潜剥术治疗复杂性肛瘘的疗效。方法复杂性肛瘘患者97例,随机分为观察组(49例,保留括约肌瘘管潜剥术)和对照组(48例,肛瘘低位切开高位挂线术)。比较两组手术时间、创面愈合时间、复发及肛门功能,手术前、后肛管静息压及最大收缩压变化,术后疼痛评分。结果两组手术时间比较差异无统计学意义(P<0.05),观察组创面愈合时间为(28.58+4.25)d,优于对照组(31.37±7.10)d,差异有统计学意义(P<0.05),观察组术后出现肛门功能变化及复发例数分别1例、2例,低于对照组7例、8例,有统计学差异;观察组术后平均肛门静息压和随访3个月后肛门最大收缩压分别为(71.4±8.1)mmHg、(106.5±9.6)mmHg,对照组分别(65.6±7.4)mmHg、(101.8±11.4)mmHg,两组比较差异有统计学意义,且对照组前、后组内压力比较差异有统计学意义(P<0.05);观察组术后第3 d.7 d静息状态下疼痛评分分别为(2.10±0.61)、(1.23±1.24),均低于对照组的(2.50±0.84)、(1.8±0.12),差异有统计学意义(P<0.05)。结论保留括约肌瘘管潜剥术治疗复杂性肛瘘疗效满意,符合微创理念,值得临床推广。Objective To compare the outcomes of anal sphincter-preserving bareness and cutting seton in complex anal fistula.Methods Ninety-seven paticnts with complex anal fistula were randomly divided into observation group(49 patients with sphincter-preserving fistula bareness)and control group(48 patients with anal fistulae with low incision and high cutting seton)。The operation time,wound healing time,recurrence and anal function,changes in anal canal resting pressure and maximum systolic pressure before and after surgery,and postoperative pain scores were comparatively studied.Results All operations were performed successfully.There was no statistically significant difference(P<0.05)between the two groups in terms of operation time,and the time of wound healing in the observation group was(28.58±4.25)d,which was better than that in the control group(31.37±7.10)d.The number of cases of postoperative anal function changes and recurrence in the observation group were 1 and 2 cases,respectively,which were lower than that in the control group(7 and 8 cases),and there was a statistical difference.The mean postoperative anal resting pressure and the maximum anal systolic pressure after 3 months of follow-up were(71.4±8.1)mmHg and.(106.5±9.6)mmHg in the observation group and(65.6±7.4)mmHgand(101.8±11.4)mmHg in the control group,respectively,and the differences between the two groups were statistically significant,and the differences between the pre-group and post-group pressure in the control group were staistically(P<0.05);the pain scores at resting state in the observation group were(2.10+0.61)and(1.23±1.24)in the 3d and 7d postoperative periods,respectively,which were lower than those in the control group(2.50+0.84)and(1.8+0.12),and the differences were saistically significant(P<0.05).Conclusion The sphincter-preserving fistula bareness procedure for complex anal fistula has satisfactory eficacy and is in line with the minimally invasive concept,which is worthy of clinical promotion.

关 键 词：复杂性肛瘘 保留括约肌 瘘管潜剥术 肛瘘切开挂线术 

分 类 号：R65[医药卫生—外科学]