拖线置管术联合RPH和复方亚甲蓝肛周皮下注射术治疗高位复杂性肛瘘合并内痔的疗效分析  

作　　者：叶孙送 陈铭 周慧慧 王辰[1] 

机构地区：[1]浙江中医药大学附属温州市中医院,325000 [2]复旦大学附属金山医院,201508

出　　处：《浙江临床医学》2025年第1期80-81,84,共3页Zhejiang Clinical Medical Journal

基　　金：国家自然科学基金资助项目(82305249);上海市金山区卫生健康委员会科研项目(JSKJ-KTZY-2021-05)。

摘　　要：目的 探讨拖线置管术、自动痔疮套扎术(RPH)和复方亚甲蓝肛周皮下注射术联合治疗高位复杂性肛瘘合并内痔的临床疗效。方法 选取2020年8月至2022年3月本院接受治疗的高位复杂性肛瘘合并内痔的患者66例,随机分为观察组和对照组,每组33例。观察组采用拖线置管术+RPH+复方亚甲蓝肛周皮下注射治疗方案,对照组采用切开挂线术+内痔结扎术治疗方案。探讨两组总有效率、术后疼痛评分及愈合时间,评估肛门功能(肛门失禁Wexner评分)和不良反应,跟踪6个月后的复发率。结果 两组治疗方案均有效。两组总有效率、复发率、愈合时及愈合后3个月肛门功能与术前相比,差异无统计学意义(P>0.05)。观察组在治疗后的第1、3、7、10、14天的疼痛值都低于对照组(P<0.05),两组愈合时间差异有统计学意义(P<0.05)。两组均未出现治疗相关不良反应。结论 拖线置管术、RPH和复方亚甲蓝肛周皮下注射术联合治疗高位复杂性肛瘘合并内痔疗效显著且安全。尤其在术后一周内,复方亚甲蓝能有效减轻患者疼痛,具有较高的临床应用价值,值得推广。Objective To investigate the clinical efficacy of combined treatment of high complex anal fistula with internal hemorrhoids using thread-dragging catheterization,rubber band ligation for hemorrhoids(RPH),and subcutaneous injection of compound methylene blue around the anus.Methods A total of 66 patients with high complex anal fistula combined with internal hemorrhoids treated from August 2020 to March 2022 in our hospital were randomly divided into an observation group and a control group,with 33 cases in each group.The observation group was treated with a combination of thread-dragging catheterization,RPH,and subcutaneous injection of compound methylene blue around the anus,while the control group was treated with incision and hanging thread surgery plus ligation of internal hemorrhoids.The total effective rate,postoperative pain score,and healing time of the two groups were compared,and anal function(anal incontinence Wexner score)and adverse reactions were evaluated,with a follow-up of the recurrence rate after 6 months.Results Both treatment plans were effective.There was no significant difference in total effective rate,recurrence rate,healing time,and anal function 3 months after healing between the two groups compared with before surgery(P>0.05).The pain scores on the 1st,3rd,7th,10th,and 14th days after treatment in the observation group were all lower than those in the control group(P<0.05),and there was a statistically significant difference in healing time between the two groups(P<0.05).No treatment-related adverse reactions occurred in either group.Conclusion The combined treatment of thread-dragging catheterization,RPH,and subcutaneous injection of compound methylene blue around the anus for high complex anal fistula with internal hemorrhoids is effective and safe.Especially within one week after surgery,compound methylene blue can effectively reduce patient pain,has a high clinical application value,and is worth promoting.

关 键 词：拖线置管术 RPH 亚甲蓝 高位复杂性肛瘘 内痔 疼痛 

分 类 号：R65[医药卫生—外科学]