低位切开留皮桥高位挂线术治疗高位复杂性肛瘘的临床疗效观察  

Low incision skin bridge-preserving high seton for high complex anal fistula:an observational study

作　　者：陈祖清[1] 张国兴 石荣[1] 梁瑞文[1] Chen Zuqing;Zhang Guoxing;Shi Rong;Liang Ruiwen(Department of Anorectal Diseases,People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350004,Fujian,China;The First School of Clinical Sciences,Fujian University of Traditional Chinese Medicine,Fuzhou 350100,Fujian,China)

机构地区：[1]福建中医药大学附属人民医院肛肠科,福建福州350004 [2]福建中医药大学第一临床医学院,福建福州350100

出　　处：《结直肠肛门外科》2021年第5期470-473,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的分析低位切开留皮桥高位挂线术治疗高位复杂性肛瘘的临床疗效。方法回顾性分析2017年1月至2019年1月福建中医药大学附属人民医院收治的120例高位复杂性肛瘘患者的临床资料,患者均接受低位切开留皮桥高位挂线术及术后随访,记录疗效、复发、术后并发症(肛门变形、肛门失禁)发生情况,创面愈合时间,术前以及术后3个月的肛管直肠压力(肛管最大收缩压、肛管静息压、直肠静息压)。结果中位随访时间为1.2年,治愈111例、好转1例、未愈2例,复发6例,其中4例复发患者接受二次低位切开留皮桥高位挂线术后治愈,另2例复发患者为克罗恩病肛瘘、带瘘生存。所有患者均未出现肛门失禁、肛门变形。术后创面愈合时间为32~73 d,平均愈合时间为(49.4±15.2)d。术后3个月的肛管最大收缩压与术前比较差异无统计学意义(P>0.05);术后3个月,直肠静息压、肛管静息压均较术前下降,差异有统计学意义(均P<0.05)。结论低位切开留皮桥高位挂线术治疗高位复杂性肛瘘疗效良好,治愈率较高,对肛门功能影响较小。Objectives To analyze the clinical effectiveness of low incision skin bridge-preserving high seton for treating pa⁃tients with high complex anal fistula.Methods This was a retrospective analysis of 120 patients with high complex anal fistula treated at the People’s Hospital Affiliated with Fujian University of Traditional Chinese Medicine between January 2017 and Jan⁃uary 2019.All patients received low incision skin bridge-preserving high seton and were followed up after the surgery.The fol⁃lowings were recorded:effectiveness,recurrence,postoperative complications(anal deformation and anal incontinence),time to wound healing,and anorectal manometry(anal maximum squeeze pressure,anal resting pressure,and rectal resting pressure)be⁃fore and 3 months after surgery.Results The median follow-up time was 1.2 years.One hundred and eleven patients were con⁃sidered cured,one improved,two not cured,and six with recurrence.Four patients with recurrence were considered cured after a second low incision skin bridge-preserving high seton,and two patients with recurrence were diagnosed with Crohn’s disease and they lived with fistula for a long time.No patients had anal incontinence or anal deformation.Postoperative time to wound healing ranged from 32 to 73 days,with a mean(SD)of 49.4(15.2)days.Anal maximum squeeze pressure at 3 months after sur⁃gery did not differ significantly from that before surgery(P>0.05).At 3 months after surgery,rectal resting and anal resting pres⁃sure decreased significantly from those before surgery(P<0.05).Conclusion Low incision skin bridge-preserving high seton is ef⁃fective for treating patients with high complex anal fistula.It has a relatively high cure rate and minimal impact on anal func⁃tion.

关 键 词：高位复杂性肛瘘 低位切开留皮桥高位挂线术 临床疗效 

分 类 号：R657.16[医药卫生—外科学]