潜剥虚挂袋形缝合术治疗高位肛瘘的临床观察  

Combined Dotted Thread-ligation and Marsupialization of Wound Edges for High Anal Fistula

作　　者：王启[1] 尹和宅[1] 洪中华[1] 童蕾[1] 钦梦婷 陈会林[1] WANG Qi;YIN He-zhai;HONG Zhong-hua(Department of Anorectal,Jiaxing Hospital of Traditional Chinese Medicine,Jiaxing(314001),China)

机构地区：[1]浙江省嘉兴市中医医院肛肠科,嘉兴314001

出　　处：《中国中西医结合外科杂志》2021年第5期764-767,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：浙江省嘉兴市科技局科研项目(2018AD32146)。

摘　　要：目的:比较潜剥虚挂法联合内口袋形缝合术与传统实挂线法治疗高位肛瘘的临床效果。方法:将高位肛瘘患者70例随机分成观察组和对照组,各35例,观察组采用潜剥虚挂法联合内口袋形缝合术(即瘘管潜行剥离,内口剜除,跨过括约肌的瘘管剥离后予虚挂引流,待瘘道肉芽组织填充后再拆线,内口剜除创面行袋形缝合),对照组采用传统实挂线(即术中实挂线,挂线后每2周紧线,直至挂线部分完全勒断)。术后观察创面愈合、疼痛、肛门功能评分及12个月内复发情况。结果:观察组术后第1 d、3 d和7 d的VAS评分分别为(1.54±0.85)、(1.14±0.77)和(0.88±0.53),低于对照组的(2.71±1.10)、(2.89±1.21)和(2.23±1.39);观察组创面愈合时间为(28.10±4.19)d,低于对照组的(35.26±4.88)d;观察组创面愈合后肛门功能Wexner评分为(0.58±0.38),低于对照组的(2.39±1.15);在术后疼痛VAS评分、创面愈合时间及Wexner评分方面,观察组优于对照组(P<0.05)。结论:潜剥虚挂法联合内口袋形缝合术治疗高位肛瘘较传统的实挂线法能更好的保护肛门括约功能,缓解术后疼痛,缩短愈合时间。Objective To compare the clinical effect of treating high anal fistula with combination of dotted thread-ligating therapy with fistula tract stripped and marsupialization of wound edges of internal opening and traditional solid thread-ligating therapy.Methods 70 patients with high anal fistula were randomly divided into observation group and control group,which 35 cases in each.Patients in observation group were treatedwith combination of dotted thread-ligatingtherapy with fistula tract stripped and marsupialization of wound edges of internal opening,and patients in control group were treated with traditional solid thread-ligating therapy.The wound healing,postoperative pain,anal function score and recurrence within 12 months were observed after operation.Results The VAS scores of the observation group were(1.54±0.85),(1.14±0.77)and(0.88±0.53)on the 1st,3rd and 7th day after operation,which were lower than those of the control group(2.71±1.10),(2.89±1.21)and(2.23±1.39).The wound healing time of the observation group was(28.10±4.19)days,which was lower than that of the control group(35.26±4.88)days.The Wexner score of anal function after wound healing in the observation group was(0.58±0.38),which was lower than that of the control group(2.39±1.15).In terms of VAS scoreof postoperative pain,wound healing time and Wexner score,the observation group was better than that of the control group(P<0.05).Conclusion The therapy of the observation group can better protect the rectal ring and the function of anal sphincter,relieve the postoperative pain and shorten the healing time.

关 键 词：高位肛瘘 潜剥虚挂法 袋形缝合术 传统实挂线 

分 类 号：R657.16[医药卫生—外科学]