高位肛瘘手术方式选取联合切口管理对患者预后的影响  

Effects of Selection of High Anal Fistula Surgery Combined with Incision Management on Prognosis of Patients

作　　者：王苏[1] 王德年 陈航航 郭盼盼 WANG Su;WANG De-nian;CHEN Hang-hang;GUO Pan-pan(Department of General Surgery,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China)

机构地区：[1]新乡医学院第三附属医院普外科二病区,河南新乡453003

出　　处：《罕少疾病杂志》2021年第5期84-87,共4页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨高位肛瘘手术方式选取联合切开管理对患者预后的影响。方法选取2017年4月至2018年4月新乡医学院第三附属医院普外科收治的高位肛瘘(HAF)患者128例(含25例脱落病例)作为研究对象,根据手术方法将患者分为A组和B组,A组71例行低位切开高位虚挂引流术,B组57例行低位切开高位挂线术,根据术后切口处理方式分组,A1组(39例)、B1组(33例)采用消炎生肌膏涂抹创面,A2组(32例)、B2组(24例),采用凡士林涂抹创面,观察手术疗效、术后14d创面面积、14d创面缩小率及创面愈合时间、肛肠压力,检测C反应蛋白(CRP)、血清干扰素(IFN-γ),发放Wexner评分评估肛门功能,视觉模拟评分(VAS)评估疼痛程度。随访至2019年8月,中位随访时间为5.1个月,记录四组复发情况。结果A1组、A2组临床疗效对比差异明显(P<0.05),A1组与A2组、B1组与B2组、A1组与B1组、A2组与B2组组间术后14d创面面积、14d创面缩小率及创面愈合时间对比差异明显(P<0.05),A1组与B1组、A2组与B2组肛管静息压、肛管最大收缩压组间对比差异明显(P<0.05),A1组与A2组、B1组与B2组、A2组与B2组组间CRP、IFN-γ对比差异明显(P<0.05),A1组与B1组、A2组与B2组组间对比差异明显(P<0.05);A1组与A2组、B1组与B2组、A1组与B1组、A2组与B2组VAS评分对比差异明显(P<0.05);四组复发率对比无明显差异(P>0.05)。结论低位切开高位虚挂引流法治疗HAF可保护肛门功能,术后辅以消炎生肌膏涂抹创面,可缩短创面愈合时间。Objective To investigate the effects of selection of high anal fistula surgery combined with incision management on the prognosis of patients.Methods 128 patients(including 25 cases lost to follow-up)with high anal fistula(HAF)who were treated in our hospital between April 2017 and April 2018 were selected as study objects.According to the surgical methods,the patients were divided into group A and B.71 patients in group A underwent low-incision and high loose seton drainage.57 patients in group B underwent low-incision and high seton.According to the treatment of incision,group A and B were regrouped.Group A1(39 cases)and B1 group(33 cases)were treated with Xiaoyan Shengji cream applied on the wound.Group A2(32 cases)and B2 group(24 cases)were treated with vaseline.The surgical effects,wound area on the 14th day after surgery,the minification rate of wound area in 14 days,wound healing time and anorectal pressure were observed.The levels of C reactive protein(CRP)and serum interferon(IFN-γ)were detected.Wexner score was issued to evaluate anorectal function,and the visual analogue scale(VAS)was used to evaluate the pain degree.Follow-up was performed till August 2019,and the median follow-up time was 51 months.The recurrence in the four groups was recorded.Results The difference between group A1 and A2 in clinical curative effect was significant(P<0.05).The differences in wound area on the 14th day after surgery,the minification rate of wound area in 14 days and wound healing time between group A1 and A2,group B1 and B2,group A1 and B1,group A2 and B2 were significant(P<0.05).The differences between group A1 and B1,group A2 and B2 in anal resting pressure and anal maximal systolic blood pressure difference were significant(P<0.05).The differences between group A1 and A2,group B1 and B2,group A2 and B2 in CRP and IFN-γwere also significant(P<0.05).The differences between group A1 and B1,group A2 and B2 were significant(P<0.05);the differences in VAS scores between group A1 and A2,group B1 and B2,group A1 and B1

关 键 词：高位肛瘘 低位切开高位虚挂引流术 消炎生肌膏 疼痛 肛门功能 复发 

分 类 号：R657.16[医药卫生—外科学]