1470nm激光瘘管闭合术治疗肛瘘的围手术期特征和肛肠动力学指标观察  

Clinical Effect of 1470nm Laser-Baser Fistula Closure On Anal Fistula & Its Influence on Anorectal Dynamic Indexes

作　　者：宋冀涛 杨晓华 李全 张景华 王玉莲 SONG Ji-tao;YANG Xiao-hua;LI Quan;ZHANG Jing-hua;WANG Yu-lian(Department of General Surgery,the Second Department of Huayou General Hospital,Cangzhou 062552,China)

机构地区：[1]华油总医院二部医院普通外科,沧州市062552

出　　处：《中国激光医学杂志》2021年第5期247-251,共5页Chinese Journal of Laser Medicine & Surgery

基　　金：中国石油天然气股份有限公司华北油田分公司科技项目(2019-HB-G0202)。

摘　　要：目的探讨1 470 nm激光瘘管闭合术治疗肛瘘的围手术期特征和肛肠动力学指标影响。方法选择2018年3月至2020年3月,肛瘘患者85例,依据不同方法分为观察组和对照组。其中,观察组患者43例采用1470 nm激光瘘管闭合术治疗;对照组患者42例采用切开挂线术治疗。比较两组围术期指标变化、创面愈合时间和住院时间;术后7 d采用视觉模拟评分法(visual analogue scale,VAS)评价疼痛情况;比较术前与术后6个月肛管压力变化及术后6个月并发症和复发情况。结果观察组术中失血量(26.8±6.8)ml少于对照组(39.8±8.0)ml;观察组手术时间(12.1±2.8)min和术后首次排便时间(2.34±0.4)d短于对照组(53.9±9.7)min、(3.2±0.6)d(P<0.05)。观察组术后并发症(4.65%)少于对照组(23.8%)(P<0.05)。观察组术后7 dVAS评分(2.31±0.5)分低于对照组(3.12±0.7)分,而创面愈合时间(23.2±4.4)d和住院时间(17.3±3.5)d短于对照组(27.8±4.0)d、(22.5±3.2)d(P<0.05)。术后6个月,两组患者的直肠静息压(Rectal resting pressure,RRP)、肛管静息压(Anal canal resting pressure,ARP)及Wexner评分均低于术前(P<0.05)。且观察组术后RRP、ARP及Wexner评分均低于对照组(P<0.05)。两组患者术后肛管最大收缩压(anal canal maximum systolic pressure, AMCP)和肛管最长收缩时间(anal canal longest contraction time, ALCT)均较治疗前降低(P<0.05),两组间治疗后AMCP和ALCT比较差异无统计学意义(P>0.05)。观察组术后6个月复发率低于对照组(P<0.05)。结论应用1 470 nm激光瘘管闭合术治疗肛瘘的疗效显著,不影响排便功能,术后并发症少,手术疼痛较轻,复发率低。Objective To investigate the clinical effect of 1 470 nm laser-based fistula closure in treating anal fistula and its influence on anorectal dynamics.Methods Altogether 85 patients with anal fistula treated from Mar.2018 to Mar.2020 were selected and divided into the observation group(n=43) and control group(n=42) by treating methods.The patients in the observation group were given 1 470 nm laser-based fistula closure.The patients in the control group were treated with incision and suture drawing.The changes of perioperative indexes,wound healing time and hospital stay were compared between the two groups.The pain was assessed with visual analogue scale(VAS)7 days after the surgery.The anal canal pressure before the operation and 6 months after the operation was compared.The complications and recurrence were observed 6 months after the operation.Results The intraoperative blood loss(26.8±6.8) ml in the observation group was less than that(39.8±8.0) ml in the control group.The operation time(12.1±2.8) min and the first postoperative defecation time(2.34±0.4) d were shorter than those(53.9±9.7) min and(3.18±0.6) d of the control group(P<0.05).The occurrence(4.65%) of postoperative complications in the observation group was less than that(23.8%) in the control group(P<0.05).The VAS score(2.31±0.5) of the observation group was lower than that(3.12±0.7) of the control group,and the wound healing time(23.2±4.4) d and hospitalization time(17.3±3.5)d were shorter than those(27.8±4.0) d and(22.5±3.2) d of the control group(P<0.05).Six months after the surgery,the rectal resting pressure(RRP),anal canal resting pressure(ARP) and Wexner scores of the patients in both groups were lower than those before the surgery(P<0.05).The RRP,ARP and Wexner scores in the observation group were lower than those in the control group(P<0.05).For both groups,the anal canal maximum systolic pressure(AMCP) and longest-contraction time of anal canal dropped after the treatment(P<0.05),and there was no significant difference between

关 键 词：激光瘘管闭术 肛瘘 肛肠动力学指标 

分 类 号：R616.4[医药卫生—外科学] R657.16[医药卫生—临床医学]