肌间闭合联合全厚推移瓣技术治疗33例括约肌上型肛瘘的临床疗效观察  

Observation on the clinical effectiveness of intermuscular suture combined with fullthickness advancement flap in the treatment of suprasphincteric anal fistula:a series of 33 cases

作　　者：杨晓媛 陈文平 林婉林 马巧玲 张磊 朱建东 赵申 杨丽敏 马智腾 黄绍伶 袁越文 Yang Xiaoyuan;Chen Wenping;Lin Wanlin;Ma Qiaoling;Zhang Lei;Zhu Jiandong;Zhao Shen;Yang Limin;Ma Zhiteng;Huang Shaoling;Yuan Yuewen(Department of Anorectal and Pelvic Floor Surgery,Xi’an Daxing Hospital,Xi’an 710016,Shaanxi,China)

机构地区：[1]西安大兴医院肛肠盆底外科,陕西西安710016

出　　处：《结直肠肛门外科》2024年第2期202-207,共6页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨肌间闭合联合全厚推移瓣技术治疗括约肌上型肛瘘的临床疗效。方法回顾性分析2020年9月至2023年6月于本科室接受肌间闭合联合全厚推移瓣技术治疗的33例括约肌上型肛瘘患者的临床资料,记录患者的治疗结果(治愈或治疗失败)、疾病相关资料、肛门功能和患者对手术治疗的满意度。结果33例患者均顺利完成手术。术后随访90~1095 d,中位随访时间为210(90,840)d。29例获得治愈,4例治疗失败。获得治愈的患者与治疗失败的患者之间既往有无脓肿/肛瘘手术史、是否为马蹄形肛瘘、是否伴有瘘管分支、是否合并脓肿的情况比较差异无统计学意义(P>0.05)。33例患者的中位术前Wexner肛门失禁评分为0(0,2)分,术后3个月时相应为0(0,4)分,两者比较差异有统计学意义(P<0.05)。术后3个月随访时,31例患者表示对手术治疗的效果满意,2例患者表示不满意。结论肌间闭合联合全厚推移瓣技术治疗括约肌上型肛瘘的短期总体临床疗效良好。Objectives To investigate the clinical effectiveness of intermuscular suture combined with full-thickness advancement flap in the treatment of suprasphincteric anal fistula.Methods A retrospective analysis was conducted on the clinical data of 33 patients with suprasphincteric anal fistula who underwent intermuscular suture combined with fullthickness advancement flap in our department from September 2020 to June 2023.The treatment outcomes(cure or treatment failure),disease-related information,anal function,and patient’s satisfaction with surgical treatment were recorded.Results All 33 patients successfully completed the surgery.Postoperative follow-up ranged from 90 to 1,095 days,with a median follow-up time of 210(90,840)days.A total of 29 patients achieved cure,while 4 patients had treatment failure.There were no significant differences in the history of abscess/anal fistula surgery,the presence of horseshoe anal fistula,the presence of fistula branches,or the presence of abscess between the cured patients and those with treatment failure(P>0.05).The median preoperative Wexner incontinence score was 0(0,2)for all 33 patients,which was significantly different from the corresponding score of 0(0,4)at 3 months postoperatively(P<0.05).At the 3-month postoperative follow-up,31 patients expressed satisfaction with the surgical outcome,while 2 patients expressed dissatisfaction.Conclusion The short-term clinical effectiveness of intermuscular suture combined with fullthickness advancement flap in the treatment of suprasphincteric anal fistula is good.

关 键 词：括约肌上型肛瘘 括约肌保留术 推移瓣 肛门外括约肌复合体 

分 类 号：R657.1[医药卫生—外科学]