经肛括约肌间切开术联合中药外敷治疗高位肛瘘疗效及术后功能分析  

Therapeutic Effect of TROPIS Combined with External Application of Traditional Chinese Medicine on High Anal Fistula and Functional Analysis after Operation

作　　者：吕文辉 刘远成 朱竞 彭西兰 刘洋 熊敏 LYU Wenhui;LIU Yuancheng;ZHU Jin;PENG Xian;LIU Yang;XIONG Min(The Third Affiliated Hospital of Anhui Medical University Hefei First People's Hospital,Hefei 230061,Anhui,China)

机构地区：[1]安徽医科大学第三附属医院,合肥市第一人民医院滨湖院区,安徽合肥230061

出　　处：《中华中医药学刊》2024年第9期236-239,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：安徽省卫生健康委员会中医药科研项目(2020zy56)。

摘　　要：目的 探讨经肛括约肌间切开(transanal opening of intersphincteric space, TROPIS)手术联合中药外敷治疗高位肛瘘的方法及对术后1年肛门功能、复发的影响。方法 选择2022年1月—2023年1月医院收治的76例高位肛瘘行手术治疗的患者作为研究对象,最终纳入60例患者,采用病例对照研究方法,按治疗方式不同分为观察组(采用TROPIS术联合中药外敷治疗)30例与对照组(采用TROPIS术治疗)30例。比较两组术后1 d、7 d创面疼痛、渗液评分。分别于术前和术后1年,采用多功能胃肠动力学检查系统测定肛管静息压、肛管最大收缩压等肛门功能指标水平,并采用Wexner失禁评分评估,随访1年,统计比较两组术后并发症发生率,比较两组复发率。结果 观察组术后1 d、7 d创面疼痛、渗液评分均低于对照组,差异有统计学意义(P<0.05)。术后1年,两组肛管静息压、肛管最大收缩压均高于术前,Wexner失禁评分低于术前,而观察组肛管静息压、肛管最大收缩压均高于对照组,Wexner失禁评分低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率6.67%低于对照组30%,两组比较,差异有统计学意义(P<0.05)。随访1年,观察组发生率1例(3.33%)低于对照组6例(20%),但差异无统计学意义(P>0.05)。结论 TROPIS术联合中药外敷治疗高位肛瘘效果显著,能够减轻患者创面疼痛,减少患者创面渗液,改善肛门功能,且术后并发症较少,复发率低。Objective To explore the method of transanal sphincter interposition incision(TROPIS)combined with external application of Chinese herbs in the treatment of high anal fistula and its effect on anal function and recurrence 1 year after opera-tion.Methods 76 patients with high anal fistula who underwent surgical treatment in our hospital from January 2022 to January 2023 were selected as the research subjects,and 60 patients were ultimately included.A case-control study method was used,and 30 patients were divided into an observation group(treated with TROPIS surgery combined with traditional Chinese medicine external application)and a control group(treated with TROPIS surgery)according to different treatment methods.Compare the scores of wound pain and exudation between the two groups on the 1st and 7th postoperative days.Before and 1 year after surger-y,the levels of anal function indicators such as resting pressure and maximum systolic pressure of the anal canal were measured using a multifunctional gastrointestinal dynamic examination system.The Wexner incontinence score was used for evaluation,fol-lowed up for 1 year,and the incidence of postoperative complications and recurrence rates were compared between the two groups.Results The observation group had lower scores of wound pain and exudation on the 1st and 7th day after surgery com-pared to the control group,with statistically significant differences(P<0.05).One year after surgery,the resting pressure and maximum systolic pressure of the anal canal in both groups were higher than before surgery,and the Wexner incontinence score was lower than before surgery.However,the observation group had higher resting pressure and maximum systolic pressure of the anal canal than the control group,and the Wexner incontinence score was lower than the control group,with a statistically signifi-cant difference(P<0.05).The incidence of complications in the observation group was 6.67%lower than that in the control group by 30%,and the difference between the two groups was st

关 键 词：经肛括约肌间切开手术 中药外敷 高位肛瘘 术后肛门功能 复发率 

分 类 号：R256.39[医药卫生—中医内科学]