肛瘘内口闭合夹治疗肛瘘的临床疗效分析  

Clinical effect of anal fistula clip in treatment of anal fistula

作　　者：杨勇[1] 张正国[1] 杨光[1] YANG Yong;ZHANG Zhengguo;YANG Guang(Department of Anorectal,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,P.R.China)

机构地区：[1]徐州市中心医院肛肠科,江苏徐州221009

出　　处：《中国普外基础与临床杂志》2023年第2期175-178,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：2021年度徐州医科大学优秀人才基金项目(项目编号:XZFY2021021);徐州市重点研发计划(社会发展)项目医药卫生面上项目(项目编号:KC22154)。

摘　　要：目的分析肛瘘内口闭合夹(anal fistula clip,AFC)治疗肛瘘的效果,并评价它的安全性。方法采用历史性队列研究方法。收集2018年9月至2021年5月期间徐州市中心医院收治的83例腺源性经括约肌肛瘘患者,其中有42例采用AFC治疗(AFC组),41例采用直肠黏膜瓣推移术(endorectal advancement flap,ERAF)治疗(ERAF组),比较2组患者的手术时间、术中出血量、术后第1、3、7天时肛门疼痛视觉模拟量表评分、创面愈合时间、术后第6个月时的肛门功能Wexner评分及临床疗效(治愈和失败)。结果2组患者均顺利完成手术。AFC组的手术时间和术中出血量短于或少于ERAF组(P<0.05),2组患者术后均无内口感染、出血等并发症发生,并且术后各时点肛门疼痛视觉模拟量表评分比较差异均无统计学意义(P>0.05)。术后中位随访时间22个月,2组患者的创面愈合时间比较差异无统计学意义(P>0.05);肛门功能Wexner评分AFC组低于ERAF组(P<0.05)且AFC组术后与术前比较差异无统计学意义(Z=–1.751,P=0.089)、而ERAF组术后高于术前(Z=–1.859,P=0.014);AFC组的治愈率与ERAF组比较差异无统计学意义(85.7%比77.5%,χ2=0.925、P=0.336)。结论从本研究结果看,AFC治疗肛瘘安全、有效,操作相对简单,术中出血量少,术后疼痛较轻,肛门功能保护较好。Objective To analyze the effect of anal fistula clip(AFC)in the treatment of anal fistula,and to evaluate its safety.Methods A historical cohort study method was conducted.Eighty-three patients with glandular transsphincteric anal fistula in the Xuzhou Central Hospital from September 2018 to May 2021 were collected,of which 42 patients underwent the AFC treatment(AFC group),41 patients underwent the endorectal advancement flap(ERAF)treatment(ERAF group).The operation time,intraoperative blood loss,visual analogue scale(VAS)score of anus pain on postoperative day 1,3,and 7,wound healing time,Wexner incontinence score of anal function on postoperative month 6,and clinical efficacy(healing and failure)were compared between the two groups.Results The operation was successfully completed in both groups.The operation time and intraoperative blood loss in the AFC group were shorter or less than those in the ERAF group(P<0.05).No complications such as internal opening infection and bleeding occurred in the two groups.There were no statistical differences in the VAS score of postoperative anus pain at all time point between the two groups(P>0.05).The median follow-up time was 22 months.There was no statistical difference in the wound healing time between the two groups(P>0.05).The Wexner score of anal function in the AFC group was lower than that in the ERAF group(P<0.05),and there was no statistical difference between after operation and before operation(Z=–1.751,P=0.089)in the AFC group,while that in the ERAF group after operation was higher than before operation(Z=–1.859,P=0.014).The healing rate had no statistical difference between the AFC group and ERAF group(85.7%versus 77.5%,χ2=0.925,P=0.336).Conclusion From the results of this study,the AFC is safe and effective in treatment of anal fistula,with the advantages of relatively simple operation,less bleeding during operation,lighter postoperative pain,and good protection of anal function.

关 键 词：肛瘘 肛瘘内口闭合夹 直肠黏膜瓣推移术 治疗效果 

分 类 号：R657.16[医药卫生—外科学]