解剖区段挂线术治疗高位马蹄形肛瘘:一项长期随访的临床对照研究  

Anatomical segmental hanging for the treatment of high-grade horseshoe anal fistula:a controlled clinical study with long-term follow-up

作　　者：徐进 毛畅 张俊 叶倩倩 黄烃 吴闯 赵文俊 汪庆明 XU Jin;MAO Chang;ZHANG Jun;YE Qianqian;HUANG Ting;WU Chuang;ZHAO Wenjun;WANG Qingming(Department of Anorectal Diseases,Baoshan District Integrated Traditional Chinese and Western Medicine Hospital,Shanghai,Shanghai 201900,China;Department of Anorectal Diseases,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海市宝山区中西医结合医院肛肠科,上海201900 [2]上海中医药大学附属曙光医院肛肠科,上海201203

出　　处：《安徽医药》2024年第9期1819-1823,共5页Anhui Medical and Pharmaceutical Journal

基　　金：上海市青年科技英才扬帆计划项目(21YF1433300);上海市科学技术委员会医学引导类(中、西医)科技支撑项目(19401933900)。

摘　　要：目的比较解剖区段挂线术与传统切开挂线术治疗高位马蹄形肛瘘在长期随访过程中的临床疗效。方法前瞻性对照研究。选择2019年3月至2020年6月于上海中医药大学附属曙光医院肛肠科接受手术治疗的86例高位马蹄形肛瘘病人,依据随机数字表法分为治疗组(解剖区段挂线术组,n=43)与对照组(传统切开挂线术组,n=43)。随访时间31~44个月(中位随访时间36个月),比较两组在术中及术后并发症情况、创面愈合及复发情况以及卫生经济学指标方面的差异。结果两组病人的一般资料情况及肛瘘既往手术史,肛瘘解剖学特征情况(肛瘘分型与内口情况等)比较差异无统计学意义(均P>0.05)。治疗组治愈率86%(37/43)高于对照组治愈率76.7%(33/43),但差异无统计学意义(P>0.05)。治疗组术中出血为15(15,20)mL小于对照组20(20,25)mL(P<0.05);治疗组术后疼痛评分[视觉模拟评分法(VAS)评分]及肛门失禁严重程度(Wexner)评分分别为2(0,3)分、0(0,0)分均优于对照组[4(2,5)分,0(0,2)分](均P<0.05);治疗组手术时间、住院时间及创面愈合时间分别为(27.67±4.85)min、6(4,7)d、(6.78±2.00)周均明显小于对照组[(32.67±7.27)min、7(6,10)d、(8.10±2.12)周](均P<0.05)。结论解剖区段挂线术能有效治愈高位马蹄形肛瘘,相较于传统切开挂线术,解剖区段挂线术治疗高位马蹄形肛瘘具有保护肛门功能、减少术中及术后并发症、缩短创面愈合时间及住院时间等方面的优势,是一种安全有效的肛门括约肌保护术式。Objective To compare the clinical efficacy of anatomical segmental ligation versus conventional incisional ligation for the treatment of high horseshoe anal fistulae during long-term follow-up.Methods In this prospective controlled study,86 patients with high-grade horseshoe anal fistulas who underwent surgical treatment at the Department of Anus and Intestines,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,from March 2019 to June 2020 were selected and divided into a treatment group(anatomical segmental ligation group,n=43)and a control group(conventional incisional ligation group,n=43)based on a randomized numerical table.The follow-up period ranged from 31 to 44 months(median follow-up period 36 months),and the differences between the two groups were compared in terms of intraoperative and postoperative complications,wound healing and recurrence,and health economic indicators.Results There was no significant difference in the general information of the patients in the two groups,the history of previous surgery or the anatomical characteristics of the anal fistula(anal fistula type,internal orifice,etc.)(P>0.05).The cure rate of the treatment group was 86%(37/43),higher than that of the control group(76.7%,33/43),but the difference was not statistically significant(P>0.05).Intraoperative bleeding in the treatment group was 15(15,20),mL less than 20(20,25)mL in the control group(P<0.05);postoperative pain scores[visual analog scale(VAS)scores]and severity of anal incontinence(Wexner)scores in the treatment group were 2(0,3)and 0(0,0),respectively,which were greater than those in the control group(P<0.05);the operation time,hospital‐ization time and wound healing time of the treatment group were 27.67±4.85 min,6(4,7)d and 6.78±2.00 weeks,respectively,which were significantly less than those in the control group[32.67±7.27 min,7(6,10)d,and 8.10±2.12 weeks,respectively](all P<0.05).Conclusions Anatomical segmental ligation can effectively cure high horseshoe anal fistulas.Compared with

关 键 词：肛瘘 挂线法 解剖区段挂线术 传统切开挂线术 大便失禁 肛门括约肌保护 

分 类 号：R657.16[医药卫生—外科学]