经括约肌间入路联合松弛挂线治疗复杂性肛瘘的临床疗效  

Clinical efficacy of transanal opening of intersphincteric space approach combined with loose seton in the treatment of complex anal fistula

作　　者：袁和学[1] 潘春来[1] 刘宗剑 张勇[1] 罗芳[2] 朱娜[1] YUAN Hexue;PAN Chunlai;LIU Zongjian;ZHANG Yong;LUO Fang;ZHU Na(Department of Anorectal Surgery,Shenyang Anorectal Hospital,Shenyang 110002,China;不详)

机构地区：[1]沈阳市肛肠医院肛肠外科,沈阳110002 [2]辽宁中医药大学附属第三医院,沈阳110000

出　　处：《实用医学杂志》2023年第9期1123-1126,1131,共5页The Journal of Practical Medicine

基　　金：辽宁省自然科学基金项目(编号:2020⁃M S⁃324)。

摘　　要：目的探讨经括约肌入路联合松弛挂线治疗复杂性肛瘘的临床疗效。方法选取我院2020年5月至2022年7月收治的复杂性肛瘘患者80例,采用随机法分为观察组40例和对照组40例。观察组患者采用经括约肌间入路联合松弛挂线术,对照组患者采用切割挂线引流术。对比两组从手术时间、住院时间、创面愈合时间、术后疼痛视觉模拟疼痛评分(VAS)、功能恢复(肛管直肠压力测定和Wexner失禁评分)。结果两组患者均达到了临床治愈效果,两组在治愈率、术前肛门功能(肛管直肠压力测定和Wexner失禁评分)、术后第7天VAS评分比较,差异无统计学意义(P>0.05);住院时间、创面愈合、手术时间、术后1、3、5天VAS评分对比差异有统计学意义(P<0.05);两组患者术后3个月以上的肛管直肠压力测定(肛门静息压和肛门缩榨压)、Wexner失禁评分比较差异有统计学意义(P<0.05)。结论经括约肌间入路联合松弛挂线术治疗与传统切割挂线引流术治疗复杂性肛瘘的相比在功能保护(肛管直肠压力测定、Wexner评分)、创面愈合、术后疼痛有明显的优势。临床证实经括约肌间入路联合松弛挂线术治疗复杂性肛瘘对肛门功能的保护是安全有效值得推广应用的。Objective This article mainly discusses the clinical effect of transcter approach combined with loose seton in the treatment of complex anal fistula.Methods Selecting 80 patients with complex anal fistula admitted to our hospital from May,2020 to July 2022,Randomly divided into treatment group and control group.40 cases in the treatment group(N=40)and 40 cases in the control group(N=40).The patients in the treatment group used intersphincter approach combined with relaxtion thread drawing.The patients in the control group were circumcised by cutting and drainage to compare the operation time,hospitalization time and wound heal⁃ing time between the two groups.VAS,functional recovery(anal canal rectal pressure measurement and Wexner in⁃continence score).Results Clinical curative effect was achieved in both groups.There were no significant differ⁃ences in cure rate,preoperative anal function(anorectal pressure measurement,Wexner incontinence score)and VAS score on the 7th day after surgery between the two groups(P>0.05).There were significant differences in length of hospital stay,wound healing,operation time and VAS scores 1,3 and 5 days after surgery(P<0.05).There were significant differences in anorectal pressure measurement(anal resting pressure and anal retraction pressure)and Wexner incontinence score more than 3 months after surgery between the two groups(P<0.05).Conclusion The treatment of complex anal fistula through intersphincter approach combined with loose seton has obvious advantages in functional protection(anorectal pressure measurement,Wexner score),wound healing and postoperative pain compared with traditional cutting and drainage.It has been proved that the treatment of compli⁃cated anal fistulas by intersphincter approach combined with relaxation and hanging line is safe and effective for the protection of anal function and worthy of popularization and application.

关 键 词：经括约肌间入路 松弛挂线 复杂性肛瘘 临床疗效 

分 类 号：R657.16[医药卫生—外科学]