改良经括约肌间瘘管结扎术在高位单纯性肛瘘治疗中的疗效与安全性分析  

Effect of Modified Transsphincter Fistula Ligation on Anal Sphincter Function and Postoperative Pain in Patients with High-level Simple Anal Fistula

作　　者：陆海 赖象权 LU Hai;LAI Xiangquan(Jinsha County Traditional Chinese Medicine Hospital Proctology,Jinsha 551800,China;The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine Department of Colorectal Medicine,Guiyang 550000,China)

机构地区：[1]金沙县中医医院肛肠科,贵州金沙551800 [2]贵州中医药大学第一附属医院肛肠一科,贵州贵阳550000

出　　处：《中华灾害救援医学》2025年第2期141-144,共4页Chinese Journal of Disaster Medicine

基　　金：贵州省中医药管理局中医药;民族医药科学技术研究专项课题(QZYY-2021-047)。

摘　　要：目的探讨在高位单纯性肛瘘治疗中采取改良经括约肌间瘘管结扎术,对患者肛门括约肌功能、术后疼痛情况的影响。方法回顾性分析2022年3月至2024年3月在金沙县中医医院就诊的70例高位单纯性肛瘘患者的临床资料。根据手术方案分为研究组(实施改良经括约肌间瘘管结扎术,35例)和对照组(实施肛瘘切除挂线术,35例)。比较两组研究对象的临床疗效、手术相关指标、术后疼痛程度、肛门括约肌功能、不良反应的发生情况。结果研究组患者的临床总有效率显著高于对照组(P<0.05)。研究组患者手术时间、术后疼痛持续时间、住院时间、创面愈合时间均显著低于对照组(P<0.05)。随着时间的增加,两组患者疼痛程度VAS评分逐渐降低,差异有统计学意义(P<0.05)。且研究组患者术后6h、12h、24h、48h VAS评分均显著低于对照组(P<0.001)。研究组患者肛管静息压、初始感觉阈值水平显著高于对照组(P<0.001);肛管高压带长度显著短于对照组(P<0.001);两组研究对象直肠静息压、肛管最大收缩压相比无显著差异(P>0.05)。研究组患者的临床并发症发生率显著低于对照组患者(P<0.05)。结论对于高位单纯性肛瘘患者,改良经括约肌间瘘管结扎术的治疗方案能更好地保护肛门括约肌功能,有效降低患者术后疼痛程度,缩短创面愈合时间,且安全性较好。Objective To investigate the impact of modified intersphincteric fistula ligation on anal sphincter function and postoperative pain in patients with high anal simple fistulas.Methods A retrospective analysis was conducted on the clinical data of 70 patients diagnosed with high anal simple fistulas who were treated at Jinsha County Traditional Chinese Medicine Hospital from March 2022 to March 2024.Based on the surgical approach,patients were divided into a study group(35 patients undergoing modified intersphincteric fistula ligation)and a control group(35 patients undergoing fistula excision and seton placement).The clinical efficacy,surgical-related metrics,postoperative pain levels,anal sphincter function,and incidence of adverse reactions were compared between the two groups.Results The overall clinical effective rate in the study group was significantly higher than that in the control group(P<0.05).Surgical duration,postoperative pain duration,length of hospital stay,and wound healing time were all significantly shorter in the study group compared to the control group(P<0.05).Over time,the Visual Analog Scale(VAS)pain scores for both groups decreased significantly,with statistical significance(P<0.05).Notably,VAS scores at 6 hours,12 hours,24 hours,and 48 hours postoperatively were significantly lower in the study group than in the control group(P<0.001).Additionally,the resting anal canal pressure and initial sensory threshold levels in the study group were significantly higher than those in the control group(P<0.001);the length of the anal canal high-pressure zone was significantly shorter in the study group.However,there were no significant differences between the two groups regarding rectal resting pressure and maximum anal contraction pressure(P>0.05).The incidence of clinical complications was significantly lower in the study group compared to the control group(P<0.05).Conclusion For patients with high anal simple fistulas,the modified intersphincteric fistula ligation technique better preserves anal sp

关 键 词：高位单纯性肛瘘 改良经括约肌间瘘管结扎术 临床疗效 

分 类 号：R657.16[医药卫生—外科学]