保留括约肌内口切除引流术治疗复杂性肛瘘的效果及对疼痛程度的影响  

Effect of sphincter preservation internal orifice resection and drainage in the treatment of complex anal fistula and its influence on pain degree

作　　者：郭喜牛 张稳存 张生东 曹宇 葛昌甫 苏华 GUO Xiniu;ZHANG Wencun;ZHANG Shengdong;CAO Yu;GE Changfu;SU Hua(Xingyuan Hospital of Yulin,Yulin 719000,China)

机构地区：[1]陕西省榆林市星元医院,陕西榆林719000

出　　处：《临床医学研究与实践》2023年第34期69-73,共5页Clinical Research and Practice

摘　　要：目的探讨保留括约肌内口切除引流术治疗复杂性肛瘘的效果及对疼痛程度的影响。方法选取2020年1月至2021年12月我院收治的80例复杂性肛瘘患者为研究对象,根据随机数字表法将其分为常规组(40例,肛门括约肌间瘘管结扎术治疗)和观察组(40例,保留括约肌内口切除引流术治疗)。比较两组的治疗效果。结果观察组的治疗总有效率高于常规组(P<0.05)。观察组的手术时长长于常规组,术中出血量多于常规组,创面愈合时间、卧床时长、住院时长短于常规组,感染发生率低于常规组(P<0.05)。术后24 h、3 d、7 d,观察组的视觉模拟评分法(VAS)评分低于常规组(P<0.05)。术后1、3个月,观察组的Wexner评分低于常规组(P<0.05)。术后,观察组的肛管静息压、肛管最大收缩压低于常规组,直肠静息压高于常规组(P<0.05)。术后,观察组的P物质(SP)、β-内啡肽(β-EP)、神经肽Y(NPY)、去甲肾上腺素(NE)、皮质醇(Cor)及C肽(CP)水平低于常规组(P<0.05)。结论保留括约肌内口切除引流术可有效改善复杂性肛瘘患者的临床指标,减轻疼痛及应激反应,促进肛肠动力恢复,值得在临床中推广及应用。Objective To explore the effect of sphincter preservation internal orifice resection and drainage in the treatment of complex anal fistula and its influence on pain degree.Methods A total of 80 patients with complex anal fistula admitted in our hospital from January 2020 to December 2021 were selected as the research objects.According to the random number table method,the patients were divided into routine group(40 cases,anal sphincter fistula ligation)and observation group(40 cases,sphincter preservation internal orifice resection and drainage).The therapeutic effects of the two groups were compared.Results The total effective rate of treatment in the observation group was higher than that in the routine group(P<0.05).The operation time of the observation group was longer than that of the routine group,the intraoperative blood loss was more than that of the routine group,the wound healing time,bed time and hospitalization time were shorter than those of the routine group,and the incidence of infection was lower than that of the routine group(P<0.05).At 24 h,3 d and 7 d after operation,the Visual Analogue Score(VAS)score of the observation group was lower than that of the routine group(P<0.05).At 1 and 3 months after operation,the Wexner score of the observation group was lower than that of the routine group(P<0.05).After operation,the anal resting pressure and anal maximum systolic pressure in the observation group were lower than those in the routine group,and the rectal resting pressure was higher than that in the routine group(P<0.05).After operation,the levels of substance P(SP),β-endorphin(β-EP),neuropeptide Y(NPY),norepinephrine(NE),cortisol(Cor)and C-peptide(CP)in the observation group were lower than those in the routine group(P<0.05).Conclusion Sphincter preservation internal orifice resection and drainage can effectively improve the clinical indexes of patients with complex anal fistula,reduce pain and stress response,and promote the recovery of anorectal motility.It is worthy of promotion and applic

关 键 词：复杂性肛瘘 肛门括约肌间瘘管结扎术 保留括约肌内口切除引流术 

分 类 号：R657.16[医药卫生—外科学]