视频辅助肛瘘治疗术对肛瘘患者应激反应和肛门功能的影响  

Effects of video-assisted anal fistula treatment on stress indicators and anal function in patients with anal fistula

作　　者：苏钶 朱晓瑜[1] 陈雪影 高渐离 Su Ke;Zhu Xiaoyu;Chen Xueying;Gao Jianli(Department of Anorectal Surgery,Lishui City People's Hospital,Lishui 323000,Zhejiang Province,China;Department of Anorectal Surgery,Zhejiang Provincial People's Hospital,Hangzhou 310000,Zhejiang Province,China)

机构地区：[1]丽水市人民医院肛肠外科,丽水323000 [2]浙江省人民医院肛肠外科,杭州310000

出　　处：《中国基层医药》2023年第11期1651-1656,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省科学技术厅临床科研基金(LY18H080162)。

摘　　要：目的探讨视频辅助肛瘘治疗术(VAAFT)对肛瘘患者应激反应指标和肛门功能的影响。方法选取丽水市人民医院2020年3月至2022年2月就诊的肛瘘患者99例进行随机对照研究,按照随机数字表法将其分为对照组(n=48,行肛瘘切除术)和观察组(n=51,行VAAFT);对比两组临床治疗效果、围术期相关指标,分析治疗前后肛门功能[肛管最大收缩压(AMCP)、肛管静息压(ARP)、肛管最长收缩时间(ALCT)、肛门失禁Wexner评分]、血清应激反应指标[去甲肾上腺素(NE)、β-内啡肽(β-EP)、神经生长因子(NGF)、P物质(SP)、皮质醇(Cor)]水平,统计两组术后并发症发生情况;对患者出院后3个月进行随访,对比两组复发情况。结果观察组总有效率为94.12%(48/51),高于对照组的79.17%(38/48)(χ^(2)=4.84,P<0.05);观察组手术时间[(34.78±4.01)min]、术中出血量[(34.48±3.86)mL]、创面愈合时间[(19.46±2.05)d]、住院时间[(12.76±1.50)d]均短于或少于对照组[(54.86±6.05)min、(36.88±4.01)mL、(25.61±2.92)d、(21.05±2.46)d](t=-19.57、-3.03、-12.18、-20.67,均P<0.05);观察组术后第1天视觉模拟评分法评分[(1.88±0.28)分]低于对照组[(3.55±0.41)分](t=-23.78,P<0.05)。术后3个月,观察组患者AMCP、Wexner评分[(171.86±18.68)mmHg、(0.39±0.07)分]均低于对照组[(180.37±19.56)mmHg、(0.52±0.09)分](t=-2.21、-8.04,均P<0.05),ARP[(50.77±5.68)mmHg]高于对照组[(48.34±5.23)mmHg](t=2.21,P<0.05),两组ALCT治疗前后差异均无统计学意义(均P>0.05)。术后3 d,两组患者NE、Cor水平均升高(均P<0.05),观察组[(252.67±29.16)μg/L、(281.34±31.27)nmol/L]均低于对照组[(304.03±32.28)μg/L、(308.72±34.18)nmol/L](t=-8.31、-4.16,均P<0.05);两组β-EP、SP、NGF术后3 d均低于术前(均P<0.05),但观察组[(62.37±6.83)ng/L、(1.87±0.23)ng/L、(30.82±4.03)mg/L]均高于对照组[(51.09±5.74)ng/L、(2.59±0.51)ng/L、(38.19±4.24)mg/L](t=8.86、8.95、8.85,均P<0.05)。两组并发症发生率差异无统计学意�Objective To investigate the effects of video-assisted anal fistula treatment(VAAFT)on stress indicators and anal function in patients with anal fistula.Methods Ninety-nine patients with anal fistula who received treatment in Lishui City People's Hospital from March 2020 to February 2022 were included in this study.They were randomly divided into a control group(n=48,undergoing fistulotomy)and an observation group(n=51,undergoing VAAFT).Clinical efficacy and the levels of various indexes during the perioperative period were compared between the two groups.Anal function[anal maximal contraction pressure,anal canal rest pressure,anal longest contraction time,anal incontinence Wexner score],and the levels of serum stress indicators[norepinephrine(NE),β-endorphin(β-EP),nerve growth factor(NGF),substance P(SP),and cortisol(Cor)]were determined before and after treatment.Postoperative complications were recorded.All patients were followed up for 3 months after surgery.Recurrence of anal fistula was compared between the two groups.Results The total effective rate in the observation group was 94.12%(48/51),which was significantly higher than 79.17%(38/48)in the control group(χ^(2)=4.84,P<0.05).The operative time,intraoperative blood loss,wound healing time,and length of hospital stay in the observation group were(34.78±4.01)minutes,(34.48±3.86)mL,(19.46±2.05)days,and(12.76±1.50)days,which were significantly shorter or less than those in the control group[(54.86±6.05)minutes,(36.88±4.01)mL,(25.61±2.92)days,(21.05±2.46)days,t=-19.57,-3.03,-12.18,-20.67,all P<0.05).On the first day after surgery,the Visual Analogue Scale score in the observation was(1.88±0.28)points,which was significantly lower than(3.55±0.41)points in the control group(t=-23.78,P<0.05).At 3 months after surgery,anal maximal contraction pressure and Wexner scores in the observation group were(171.86±18.68)mmHg and(0.39±0.07)points,which were significantly lower than(180.37±19.56)mmHg and(0.52±0.09)points in the control group(t=-2.21,-8.04,

关 键 词：直肠瘘 肛瘘切除术 电视辅助外科手术 肛管 手术后并发症 复发 

分 类 号：R657.16[医药卫生—外科学]