可自行调节挂线在高位复杂性肛瘘中的临床应用  

Clinical application of self-adjustable seton in high complex anal fistula

作　　者：沈军权 徐焕军[1] 周海涛 Jun-Quan Shen;Huan-Jun Xu;Hai-Tao Zhou(Department of Anorectal Surgery,Yuyao People’s Hospital,Yuyao 315400,Zhejiang Province,China)

机构地区：[1]余姚市人民医院肛肠外科,浙江省余姚市315400

出　　处：《世界华人消化杂志》2023年第2期66-72,共7页World Chinese Journal of Digestology

基　　金：宁波市医学科技计划项目,No.2019Y61;余姚市科技计划项目,No.2020YYB01。

摘　　要：背景切割挂线仍是目前治疗高位复杂性肛瘘的主要方法之一,在其治疗过程中需多次紧线直至脱落.传统的紧线方式不但操作过程复杂、患者痛苦,且需要专科器械及专科医师操作,非常不便.可自行调节挂线可解决上述问题.目的探讨可自行调节挂线在治疗高位复杂性肛瘘的临床可行性.方法选取余姚市人民医院肛肠外科2019-07/2022-06符合入组条件的61例肛瘘患者,随机分为可自行调节挂线的试验组(29例)和传统切割挂线(分次紧线)的对照组(32例).两组患者年龄、性别、身体质量指数(body massindex,BMI)、文化程度、疾病性质等方面比较差异无统计学意义,具有可比性.在治疗方式上均对肛瘘主管进行切割挂线,但术后紧线方式不同:试验组行可自行调节挂线,对照组行传统的切割挂线.比较两组紧线脱落时间、总紧线次数、门诊紧线次数、紧线疼痛程度、创面愈合时间及疗效方面差异.结果试验组1例,对照组2例,在手术过程中实行了引流挂线,术后予以剔除.试验组与对照组在紧线脱落时间、总紧线次数、创面愈合时间、疗效等方面差异无统计学意义;在门诊紧线次数试验组要少于对照组,在平均紧线疼痛程度试验组要低于对照组,差异均有统计学意义(P<0.001).结论可自行调节挂线在紧线脱落时间、创面愈合时间及疗效可达到传统切割挂线的效果,但其操作的便捷性优于传统紧线,可以在家完成紧线调节,减少门诊紧线次数,且切割疼痛程度更轻,医疗费用更低,是目前比较适宜的紧线方式,今后可作为一种适宜技术在医共体内、其他基层医院推广及应用.BACKGROUND Cutting seton is still one of the main methods for the treatment of high complex anal fistula at present.During the treatment,the thread should be tightened many times until it falls off.The traditional thread tightening method is not only complicated in operation and painful for patients,but also requires specialized equipment and doctors to operate,which is very inconvenient.The above problems can be solved by self-adjusting seton.AIM To explore the clinical feasibility of self-adjustable seton in the treatment of high complex anal fistula.METHODS Sixty-one patients with anal fistula who met the inclusion criteria at the Department of Anorectal Surgery of Yuyao People’s Hospital from July 2019 to June 2022 were selected and randomly divided into an experimental group(n=29)with self-adjustable seton and a control group(n=32)with traditional cutting seton(tightening the seton by stages).There was no significant difference between the two groups in terms of age,gender,body mass index,educational level,or the nature of disease(P>0.05).The main pipe of the anal fistula was all treated with cutting and seton,but the postoperative tightening methods were different:A selfadjustable seton was used in the experimental group,while a traditional cutting seton in the control group.Tighteningfalling off time,total tightening times,outpatient tightening times,the degree of tightening-related pain,wound healing time,and efficacy were compared between the two groups.RESULTS One patient in the experimental group and two in the control group were intraoperatively treated with drainage and seton,which was removed after surgery.There was no significant difference between the experimental group and the control group in terms of the time of thread tightening off,total thread tightening times,wound healing time,or efficacy(P>0.05).Outpatient tightening times were less,and the average degree of tightening-related pain was lower in the experimental group than in the control group(P<0.001).CONCLUSION Self-adjustable seton ca

关 键 词：肛瘘 高位复杂性肛瘘 切割挂线 可自行调节挂线 紧线 疼痛 

分 类 号：R657.16[医药卫生—外科学]