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肛门括约肌间切开术治疗高位肛瘘的临床研究
郭高正,郑雪平,谭妍妍,周峰,王兴宝,石佳勇,王怡明
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南京中医药大学南京 210000;南京中医药大学附属南京中医院肛肠中心南京 210000
摘要:
目的:研究肛门括约肌间切开术治疗高位肛瘘之临床疗效。方法:将72例高位肛瘘患者按随机数字表法随机分为对照组(切开挂线术组)和试验组(括约肌间切开术组),各36例。比较两组手术基本情况、临床疗效、肛门功能、创面面积、局部疼痛及并发症等方面的差异。结果:试验组住院时间(8.22±2.10)d,短于对照组的(14.17±2.83)d;试验组创面愈合时间(35.75±11.15)d,短于对照组的(55.69±13.42)d;术后3个月试验组肛管静息压、肛管最大收缩压分别为(58.39±6.72)mmHg、(143.72±8.24)mmHg,均高于对照组的(51.25±4.33)mmHg、(126.75±11.49)mmHg;术后3个月试验组Wexner大便失禁评分(0.56±0.61)分,低于对照组的(3.25±0.81)分;在手术当天、术后第7天换药时、术后第14天这3个时间点试验组创面面积分别为(10.70±1.67)cm2、(8.34±1.18)cm2、(6.25±1.13)cm2,均小于对照组的(20.52±1.58)cm2、(16.26±2.37)cm2、(13.98±2.24)cm2;在术后第7 h、术后首次排便时、术后第7天排便时这3个时间点试验组疼痛指数分别为(3.44±0.91)分、(4.17±0.77)分、(2.64±0.82)分,均低于对照组的(6.25±0.73)分、(7.22±1.20)分、(5.28±1.49)分;试验组术后并发症发生率为17%,低于对照组的53%(均P<0.05)。两组手术在复发率、临床疗效方面无显著性差异(均P>0.05)。结论:相比于切开挂线术,括约肌间切开术治疗高位肛瘘具有更好地维护肛门功能、创伤小、康复快、疼痛轻、并发症少等显著优势。
关键词:  括约肌间感染机制  肛门括约肌间切开术  高位肛瘘
DOI:10.3969/j.issn.1007-6948.2020.02.018
投稿时间:2020-07-15
基金项目:南京市“十三五”规划名中医工作室建设项目(ZXP-2019-NJ)
Clinical Study of Cutting of Intersphincter Space in the Treatment of High Anal Fistula
GUO Gao-zheng,ZHENG Xue-ping,TAN Yan-yan
Abstract:
Objective To study the clinical effect of cutting of intersphincter space in thetreatment of high anal fistula. Methods According to the method of random number table, 72 patients with high anal fistula were randomly divided into control group(cutting seton) (n=36) and experimental group(cutting of intersphincter space) (n=36).The basic situation ofoperation, clinical effect, anal function, wound area, local pain and complications were compared between the two groups. Results The hospitalization time of the test group was (8.22±2.10) days, which was shorter than that of the control group (14.17±2.83) days. The wound healing time in the test group was (35.75±11.15) days, which was shorter than that in the control group (55.69±13.42) days. Three months after operation, the anal resting pressure and the maximum anal systolic pressure in the test group were (58.39±6.72) mmHg and (143.72±8.24) mmHgrespectively, which were higher than those in the control group (51.25±4.33) mmHg and (126.75±11.49) mmHg. Three months after operation, the Wexner score of fecal incontinence in the experimental group was lower than that in the control group (0.56±0.61), which was lower than that in the control group (3.25±0.81). On the day of operation, 7 days after operation and 14 days after operation, the wound area of the test group was (10.70±1.67) cm2, (8.34±1.18) cm2 and (6.25±1.13) cm2 respectively, which were smaller than those of the control group (20.52±1.58) cm2, (16.26±2.37) cm2 and (13.98±2.24) cm2 respectively. The pain index of the test group was (3.44±0.91), (4.17±0.77) and (2.64 ±0 . 82 ) at 7 hours, the first defecation and the 7th day after operation respectively, which were lower than those of the control group (6.25±0.73), (7.22±1.20) and (5.28±1.49).The incidence of postoperative complications in the test group was 17%, which was lower than that in the control group (53%) (all P<0.05).There was no signi?cant difference in recurrence rate and clinical curative effect between the two groups (all P>0.05). Conclusion Compared with cutting seton, cutting of intersphincter space in the treatment of high anal ?stula has signi?cant advantages such as
Key words:  Mechanism of intersphincter infection  cutting of intersphincter space  high anal ?stula

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