经括约肌间瘘管结扎术与传统肛瘘手术治疗低位单纯性肛瘘的疗效对比分析  

Comparative analysis of the effect of ligation of intersphincter fistula and traditional anal fistula in the treatment of low simple anal fistula

作　　者：肖倩[1] 吴优[1] 张磊昌[2] 马晓飞 张伟华[4] 许晨[4] XIAO Qian;WU You;ZHANG Leichang;MA Xiaofei;ZHANG Weihua;XU Chen

机构地区：[1]广西壮族自治区柳州市人民医院,广西柳州545006 [2]江西省中医院,江西南昌330000 [3]江西中医药大学,江西南昌330006 [4]天津市人民医院,天津300191

出　　处：《中医临床研究》2021年第33期125-128,共4页Clinical Journal Of Chinese Medicine

基　　金：项目名称:基于ROR-γt/IL-17F信号通路分析壮医药线点灸干预溃疡性结肠炎大鼠的机制,国家自然科学基金项目(81760871);项目名称:VASH1在结直肠癌表达及其抗血管生成研究,天津市卫计委自筹项目(2014KZ053);项目名称:滋水清肝饮加减对围绝经期慢性便秘及对患者雌激素的影响,广西壮族自治区中医药管理局(GZZC2020380)。

摘　　要：目的:研究经括约肌间瘘管结扎术(Ligation of intersphincteric fistula tract,LIFT)治疗低位单纯性肛瘘的疗效及安全性,为临床治疗方案的选择提供指导意义。方法:选择2019年7-9月收治的30例低位单纯性肛瘘患者,所有患者随机分成两组,观察组采用LIFT手术治疗,对照组采用肛瘘切开术,每组15例。对两组患者的临床疗效、创面愈合时间、术后48 h疼痛程度视觉模拟评分法(Visual Analogue Scale,VAS)评分、肛门功能Wexner评分、肛管直肠压力测定、复发率进行对比分析。结果:观察组治愈率80.00%(12/15);对照组治愈率86.67%(13/15)。观察组在治愈率上与对照组比较差异无统计学意义(P> 0.05)。观察组在创面愈合时间、术后48 hVAS评分、术后1个月、3个月Wexner评分方面明显优于对照组,差异有统计学意义(P <0.01)。术前与术后3个月对比,观察组肛管直肠的静息压和肛管最大收缩压比较,差异均无统计学意义(P>0.05)。对照组肛管直肠的静息压差异无统计学意义(P> 0.05),肛管最大收缩压差异有统计学意义(P <0.05)。对照组术后3个月肛管最大收缩压明显低于观察组术后3个月肛管最大收缩压,差异有统计学意义(P <0.05)。观察组和对照组半年累积复发概率分别是16.66%(2/12)和15.38%(2/13),χ^(2)=2.12,P=0.89。结论:LIFT手术与传统切开术比较,LIFT手术切口小,恢复快,疼痛轻微,最大限度的保留肛门括约肌,无肛门失禁发生,符合微创理念,是治疗肛瘘更加理想的术式。Objective: To study the efficacy and safety of ligation of intersphincteric fistula tract(LIFT) on low simple anal fistula,and to provide guidance for the selection of clinical treatment. Methods: From July to September 2019, 30 patients with low simple anal fistula were randomly divided into two groups. The observation group was treated with lift operation, and the control group was treated with anal fistula incision, with 15 cases in each group. The clinical effect, wound healing time, the VAS score of pain degree 48 hours after operation, Wexner score of anal function, anorectal pressure measurement and recurrence rate were compared between the two groups.Results: The cure rate was 80.00%(3/15) in the observation group and 86.67%(2/15) in the control group. There was no significant difference in the cure rate between the observation group and the control group(P>0.05). The observation group was significantly better than the control group in wound healing time, 48 hours VAS score, 1 month and 3 months Wexner score(P<0.01). There was no significant difference in the resting pressure and the maximum systolic pressure between the two groups before and 3 months after operation(P>0.05).There was no significant difference in the resting pressure of anorectum in the control group(P>0.05), but there was significant difference in the maximum anal systolic pressure(P<0.05). The maximum anal systolic pressure of the control group 3 months after operation was significantly lower than that of the observation group 3 months after operation, and the difference was statistically significant(P<0.05). The cumulative recurrence rate of the observation group and the control group in half a year was 16.66%(2/12) and 15.38%(2/13), respectively,χ^(2)=5.07, P=0.03. Conclusion: LIFT was compared with traditional incision, lift is a more ideal operation for anal fistula because of its small incision, fast recovery, slight pain, maximum retention of anal sphincter and no occurrence of anal incontinence.

关 键 词：经括约肌间瘘管结扎术 肛瘘切开术 肛瘘 微创 

分 类 号：R657.16[医药卫生—外科学]