部分瘘管切开联合肛瘘栓填塞治疗括约肌上型肛瘘的临床疗效观察

doi:10.3969/j.issn.1671-7171.2018.01.019

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摘要【目的】探讨部分瘘管切开联合肛瘘栓填塞治疗括约肌上型肛瘘的临床效果。【方法】选取2013年12月至2016年10月北京市肛肠医院收治的58例括约肌上型肛瘘患者,按照随机数表法将其分为对照组和观察组,每组各29例。对照组采用传统切开挂线术,观察组采用部分瘘管切开联合肛瘘栓填塞治疗。比较两组术后瘢痕面积、创口愈合时间、疼痛持续时间、住院时间;比较两组患者术后1个月并发症发生率、术前及术后1 d两组肛门功能指标(肛管静息压、直肠静息压、肛门最大收缩压)、肛门失禁评分,术后1 d、7 d疼痛评分变化情况。【结果】观察组瘢痕面积、创口愈合时间及疼痛持续时间、住院时间均小于对照组,差异有统计学意义(P<0.05)。两组术前肛管静息压、直肠静息压、肛门最大收缩压比较,差异无统计学意义(P>0.05);对照组术后肛管静息压、直肠静息压、肛门最大收缩压均低于术前,观察组术后肛管静息压、直肠静息压、肛门最大收缩压均高于对照组,差异均有统计学意义(P<0.05)。术前两组Wexner评分比较,差异无统计学意义(P>0.05);观察组术后1 d的Wexner评分、VAS评分及术后7 d VAS评分均低于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率为3.45%(1/29)显著低于对照组的27.58%(8/29),差异有统计学意义(χ²=4.735,P=0.03<0.05)。【结论】采用部分瘘管切开联合肛瘘栓填塞治疗括约肌上型肛瘘临床效果较好,术后创伤小,患者疼痛感较轻,对肛门功能影响较小,且安全性较高,具有推广价值。

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关键词 ：肛管, 直肠瘘/外科学, 栓塞, 治疗性, 治疗结果

Abstract：【Objective】To investigate the clinical effect of partial fistula incision combined with anal fistula embolization in the treatment of sphincter type Ⅰ anal fistula.【Methods】From December 2013 to October 2016, 58 patients with sphincter type Ⅰ anal fistula in Beijing Erlonglu Hospital were randomly divided into the control group and the study group, with 29 cases in each group. Patients in the control group were treated with sphincter fistula ligation and patients in the study group were treated with partial fistula incision combined with anal fistula. Postoperative related indicators (scar area, wound healing time, pain duration, length of hospital stay) were measured, as well as the incidence of complications one month after surgery, anus function indexes (anal resting pressure, rectal resting pressure, anal maximum systolic pressure) pre-operatively and on the first day post-operation, and anal incontinence score (Wexner) and pain score (VAS) on the 1st and 7th day postoperation. The measurements were statistically compared between the two groups.【Results】The scar area, the time of wound healing, pain duration and the length of hospital stay in the study group were less than those in the control group, the differences were statistically significant (P <0.05); There were no significant differences in the anal resting pressure, rectal resting pressure, anal maximum systolic pressure between the two groups before operation (P>0.05), while these measurements in the study group after operation were significantly higher than those in the control group (P<0.05). The Wexner score of the two groups before operation showed no significant difference (P>0.05); however, the Wexner score on the first day after operation and VAS scores on the 1st and 7th day after operation in the study group were significantly lower than those in the control group (P<0.05). The incidence of complications in the study group 3.45% (1/29), which was lower than that in the control group (27.58%, 8/29); the difference was statistically significant (P<0.05).【Conclusion】Treatment of sphincter type Ⅰ anal fistula using partial fistula incision combined with anal fistula embolization shows better clinical effect with less trauma and pain after surgery. It does not affect the anus function greatly and has much less complications.

Key words： Anal Canal Rectal Fistula/SU Embolization, Therapeutic Treatment Outcome

收稿日期: 2017-04-21

PACS:

R657.16

引用本文:

于锦利,段宏岩,王培馨,郝鹏,孙磊. 部分瘘管切开联合肛瘘栓填塞治疗括约肌上型肛瘘的临床疗效观察[J]. 医学临床研究, 2018, 35(1): 62-64,67.
YU Jin-li,DUAN Hong-yan,WANG Pei-xin,et al. A Prospective Study of Partial Fistula Incision Combined with Anal Fistula Embolization in the Treatment of Sphincter Type Ⅰ Anal Fistula. JOURNAL OF CLINICAL RESEARCH, 2018, 35(1): 62-64,67.

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http://www.jcr.net.cn/CN/10.3969/j.issn.1671-7171.2018.01.019 或 http://www.jcr.net.cn/CN/Y2018/V35/I1/62

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