LIFT与ERAF术治疗复杂性肛瘘的临床疗效及对术后疼痛介质水平的影响  

Clinical efficacy of LIFT and ERAF in the treatment of complex anal fistula and its effect on postoperative pain mediator levels

作　　者：谭震 秦澎湃[2] 田磊[1] TAN Zhen;QIN Peng-pai;TIAN Lei(Department of Anorectal Surgery,Beijing Anorectal Hospital(Beijing Erlong Road Hospital),Beijing 100120,China;Department of Science and Education Section,Beijing Anorectal Hospital(Beijing Erlong Road Hospital),Beijing 100120,China)

机构地区：[1]北京市肛肠医院(北京市二龙路医院)肛肠外科,北京100120 [2]北京市肛肠医院(北京市二龙路医院)科教科,北京100120

出　　处：《临床和实验医学杂志》2022年第16期1736-1740,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市优秀人才培养资助项目(编号:2019-XCRC)。

摘　　要：目的 探讨括约肌间瘘管结扎术(LIFT)与经肛门直肠黏膜瓣推移术(ERAF)治疗复杂性肛瘘的临床疗效及对术后疼痛介质水平的影响。方法 前瞻性选取2018年8月至2020年8月复杂性肛瘘患者104例,按随机数字表法分为观察组与对照组,各52例。观察组患者行LIFT术,对照组患者行ERAF术。比较两组患者围术期的手术时间、住院时间、术中出血量、创口面积、创面愈合时间,比较两组患者术前及术后7 d直肠静息压、肛肠静息压、肛管最大收缩压、Wexner评分、P物质、5-羟色胺、多巴胺、去甲肾上腺素(NE),记录并比较患者1年随访期间出现的并发症。结果观察组手术时间、住院时间、术中出血量、创口面积、创面愈合时间分别为(31. 35±11. 54) min、(6. 61±1. 32) d、(27. 87±4. 33) mL、(2. 58±0. 79) cm^(2)、(25. 46±5. 22) d,显著少于对照组[(48. 66±10. 14) min、(12. 42±2. 74) d、(45. 35±5. 67) mL、(8. 41±1. 28) cm^(2)、(46. 13±6. 92) d],差异均有统计学意义(P<0.05)。两组术后7 d直肠静息压、肛肠静息压显著低于术前,肛管最大收缩压显著高于术前,Wexner评分术后7 d显著低于术前,差异均有统计学意义(P<0.05);两组术后直肠静息压、肛肠静息压、肛管最大收缩压组间对比,差异均无统计学意义(P>0.05),观察组为(0. 24±0. 11)分,显著低于对照组[(0. 86±0. 51)分],差异有统计学意义(P<0.05)。两组术后7 d P物质、5-羟色胺、多巴胺、NE水平均显著高于术前,但观察组P物质、5-羟色胺、多巴胺、NE水平为(167. 22±20. 41)、(817. 64±77. 36)、(13. 05±1. 78)、(364. 72±42. 13) ng/mL,显著低于对照组[(188. 74±21. 11)、(921. 14±105. 17)、(15. 11±1. 91)、(511. 04±48. 84) ng/mL],差异均有统计学意义(P<0.05)。随访期间观察组并发症总发生率13. 46%显著低于对照组30. 77%,差异有统计学意义(P<0.05)。结论 LIFT及ERAF术均可用于复杂性肛瘘治疗,LIFT术整体效果相对更好。Objective To investigate the clinical efficacy of ligation of intersphincteric fistula(LIFT)and endorectal mucosal advancement flap(ERAF)in the treatment of complex anal fistulas and their effect on postoperative pain mediator levels.Methods A prospective study was carried out,and 104 patients with complex anal fistula who were treated in Beijing Anorectal Hospital(Beijing Erlong Road Hospital)from August 2018 to August 2020 were prospectively selected as the study subjects,and were divided into observation group and control group according to the random number table method,with 52 cases in each group.Patients in the observation group underwent LIFT surgery,and patients in the control group underwent ERAF surgery.The perioperative operation time,hospital stay,intraoperative bleeding,wound area and wound healing time of the two groups were compared.The rectal resting pressure,anorectal resting pressure,maximum anal systolic pressure,Wexner score,substance P,serotonin,dopamine and norepinephrine(NE)were compared before and 7 days after operation.The complications that occurred during the 1-year follow-up of the patients were recorded and compared.Results The operation time,hospital stay,intraoperative bleeding,wound area and wound healing time in the observation group were(31.35±11.54)min,(6.61±1.32)d,(27.87±4.33)ml,(2.58±0.79)cm^(2) and(25.46±5.22)d,respectively,which were significantly lower than those in the control group[(48.66±10.14)min,(12.42±2.74)d,(45.35±5.67)mL,(8.41±1.28)cm^(2),(46.13±6.92)d],the differences were statistically significant(P<0.05).The rectal resting pressure and anorectal resting pressure of the two groups were significantly lower than those before operation,the maximum anal systolic pressure was significantly higher than that before operation,and the Wexner score was significantly lower than that before operation,the differences were statistically significant(P<0.05);there were no significant differences in postoperative rectal resting pressure,anorectal resting pressure and max

关 键 词：复杂性肛瘘 括约肌间瘘管结扎术 经肛门直肠黏膜瓣推移术 疼痛介质 随访 

分 类 号：R657.16[医药卫生—外科学]