对比经肛括约肌间切开术和切开挂线法治疗高位肛瘘对患者肛门功能恢复和复发的影响  

Comparison of the effects of transanal sphincterotomy and incision and thread-hanging method on the recovery of anal function and recurrence in patients with high anal fistula

作　　者：何志刚 何永忠 谢伟 何海 HE Zhi-gang;HE Yong-zhong;XIE Wei(Shawan People's Hospital in Panyu District,Guangzhou 511483,China)

机构地区：[1]广州市番禺区沙湾人民医院,511483 [2]广州市番禺区何贤纪念医院,511400

出　　处：《中国现代药物应用》2024年第2期27-30,共4页Chinese Journal of Modern Drug Application

摘　　要：目的探讨经肛括约肌间切开术和切开挂线法治疗高位肛瘘的临床疗效及其对患者肛门功能恢复和复发的影响。方法91例高位肛瘘患者,根据手术方法的不同分为经肛括约肌间切开组(50例)和切开挂线组(41例)。经肛括约肌间切开组患者采用经肛括约肌间切开术进行治疗,切开挂线组患者采用切开挂线法进行治疗。比较两组患者临床疗效、临床指标(手术时间、愈合时间、术中出血量及住院时间)、视觉模拟评分法(VAS)评分、大便失禁严重度(Wexner)评分、肛门功能及复发情况。结果治疗后经肛括约肌间切开组临床总有效率96.00%高于切开挂线组的78.05%(P<0.05)。经肛括约肌间切开组患者手术时间(58.98±3.71)min、愈合时间(22.24±1.71)d及住院时间(9.38±1.59)d均短于切开挂线组的(75.73±2.95)min、(27.44±1.86)、(14.73±2.05)d,术中出血量(84.96±2.85)ml少于切开挂线组的(96.07±2.71)ml(P<0.05)。术后1个月,两组VAS评分与Wexner评分均较本组术前降低,且经肛括约肌间切开组VAS评分(1.54±0.61)分与Wexner评分(1.22±0.42)分均低于切开挂线组的(2.17±0.70)、(1.93±0.82)分(P<0.05)。术后3个月,两组肛管最大收缩压与肛管最大静息压均较本组术前降低,但经肛括约肌间切开组肛管最大收缩压(16.23±1.62)kPa与肛管最大静息压(8.03±1.01)kPa均大于切开挂线组的(11.17±1.78)、(4.38±0.92)kPa(P<0.05)。结论相较于切开挂线法,经肛括约肌间切开术在高位肛瘘中的临床疗效更加理想,可有效促进患者恢复,同时减轻患者疼痛程度,保护患者肛门功能。Objective To explore the clinical efficacy of transanal sphincterotomy and incision and thread-hanging method in the treatment of high anal fistula and its impact on the recovery of anal function and recurrence in patients.Methods 91 patients with high anal fistula were divided into the transanal sphincter incision group(50 cases)and the incision and thread-hanging group(41 cases)based on different surgical methods.The patients in the transanal sphincter incision group were treated with transanal sphincterotomy,while the patients in the incision and thread-hanging group were treated with incision and thread-hanging.Comparison was made on the clinical efficacy,clinical indicators(surgical time,healing time,intraoperative bleeding volume,and hospitalization time),visual analogue scale(VAS)score and Wexner score,anal function,and recurrence between the two groups.Results After treatment,the total clinical effective rate of 96.00%in transanal sphincter incision group was higher than 78.05%in incision and thread-hanging group(P<0.05).The surgical time of transanal sphincter incision group was(58.98±3.71)min,the healing time was(22.24±1.71)d,and the hospitalization time was(9.38±1.59)d,which were shorter than(75.73±2.95)min,(27.44±1.86)d,and(14.73±2.05)d in incision and thread-hanging group;and the intraoperative bleeding volume of(84.96±2.85)ml was less than(96.07±2.71)ml in incision and thread-hanging group(P<0.05).At 1 month after surgery,both VAS scores and Wexner scores decreased in both groups,with a greater decrease in the transanal sphincter incision group[(1.54±0.61)and(1.22±0.42)points]compared to the incision and thread-hanging group[(2.17±0.70)and(1.93±0.82)points](P<0.05).After 3 months of surgery,the maximum systolic pressure and resting pressure of the anal canal in both groups decreased.The maximum systolic pressure and resting pressure of the anal canal in transanal sphincter incision group[(16.23±1.62)and(8.03±1.01)kPa]were higher than those in incision and thread-hanging group[(11.17±1

关 键 词：高位肛瘘 切开挂线法 经肛括约肌间切开术 肛门功能 

分 类 号：R657.16[医药卫生—外科学]