经肛括约肌间切开术治疗高位括约肌间型肛瘘和括约肌上型肛瘘的临床疗效观察  

Observation of the clinical effectiveness of transanal opening of the intersphincteric space in the treatment of high intersphincteric anal fistula and suprasphincteric anal fistula

作　　者：黄路桥 李姗姗[1] 杨勇[1] 孟庆良[1] 梁春晖[1] 潘冬[1] 孙尚颖 谢光伟[1] 张正国[1] Huang Luqiao;Li Shanshan;Yang Yong;Meng Qingliang;Liang Chunhui;Pan Dong;Sun Shangying;Xie Guangwei;Zhang Zhengguo(Department of Anorectal Surgery,Xuzhou Central Hospital,Xuzhou 221009,Jiangsu,China)

机构地区：[1]徐州市中心医院肛肠科,江苏徐州221009

出　　处：《结直肠肛门外科》2024年第2期208-211,共4页Journal of Colorectal & Anal Surgery

基　　金：徐州市科学技术局社会发展项目(KC21245)。

摘　　要：目的探讨经肛括约肌间切开术治疗高位括约肌间型肛瘘和括约肌上型肛瘘的临床疗效。方法以2021年9月至2023年6月在徐州市中心医院肛肠科接受手术治疗的124例高位括约肌间型肛瘘和括约肌上型肛瘘患者作为研究对象,其中观察组(接受经肛括约肌间切开术治疗)和对照组(接受切开挂线术治疗)各有62例。比较两组的临床疗效(总有效率),手术相关指标(手术时间、住院时间、创面愈合时间),术后第1、第7天的疼痛程度(VAS疼痛评分)和术后3个月的肛门功能(Wexner肛门失禁评分)。结果观察组的总有效率为95.2%(59/62),对照组的总有效率为91.9%(57/62),两组比较差异无统计学意义(P>0.05)。观察组的手术时间长于对照组,住院时间和创面愈合时间短于对照组,差异有统计学意义(P<0.05)。术后第1、第7天,观察组的VAS疼痛评分低于对照组,差异有统计学意义(P<0.05)。术后3个月,观察组的Wexner肛门失禁评分为0(0,1)分,低于对照组的1(0,3)分,差异有统计学意义(P<0.05)。结论经肛括约肌间切开术治疗高位括约肌间型肛瘘和括约肌上型肛瘘的临床疗效良好。与切开挂线术相比,经肛括约肌间切开术的手术创伤小、术后疼痛轻,患者术后恢复快。Objectives To investigate the clinical effectiveness of transanal opening of the intersphincteric space(TROPIS)in the treatment of high intersphincteric anal fistula and suprasphincteric anal fistula.Methods A total of 124 patients with high intersphincteric anal fistula and suprasphincteric anal fistula who underwent surgical treatment at the Department of Anorectal Surgery,Xuzhou Central Hospital from September 2021 to June 2023 were selected as the study subjects.The observation group(receiving TROPIS)and the control group(receiving incision-thread-drawing)had 62 cases each.The clinical effectiveness(total effective rate),surgical indicators(operation time,hospital stay,wound healing time),pain levels[visual analog scale(VAS)pain scores]on the 1st and 7th day after surgery,and anal function(Wexner incontinence score)at 3 months after surgery were compared between the two groups.Results The total effective rate was 95.2%(59/62)in the observation group and 91.9%(57/62)in the control group,with no statistically significant difference between the two groups(P>0.05).The operation time in the observation group was longer than that in the control group,while the hospital stay and wound healing time were shorter than those in the control group,with statistically significant differences(P<0.05).On the 1st and 7th day after surgery,the VAS pain scores in the observation group were lower than that in the control group,with statistically significant differences(P<0.05).At 3 months after surgery,the Wexner incontinence score in the observation group was 0(0,1),which was lower than that in the control group 1(0,3),with a statistically significant difference(P<0.05).Conclusion TROPIS has a good clinical effectiveness in the treatment of high intersphincteric anal fistula and suprasphincteric anal fistula.Compared with incision-thread-drawing,TROPIS has less surgical trauma,less postoperative pain,and faster patient recovery.

关 键 词：高位括约肌间型肛瘘 括约肌上型肛瘘 经肛括约肌间切开术 切开挂线术 

分 类 号：R657.1[医药卫生—外科学]