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松紧结合挂线法治疗高位肛瘘对肛门功能的影响
谭金枝,肖婉晴,詹本龙,何芝,姬偃修
0
浏阳市中医医院肛肠乳腺科长沙 410300;重庆市北培区中医院重庆 400700
摘要:
目的:比较松紧结合挂线和传统挂线疗法对高位肛瘘患者术后肛门功能Wexner评分及肛肠动力学的影响。方法:选取2018年1月—2020年1月于湖南省浏阳市中医医院肛肠科住院的高位肛瘘住院患者60例,随机分为对照组及治疗组,每组30例,对照组采用传统挂线法,治疗组采用松紧结合挂线疗法,比较两组患者术后总体有效率、肛门功能Wexner评分、肛门直肠动力指标包括肛管最大收缩压、直肠静息压、肛管静息压变化情况。结果:术后治疗组总体有效率为80%,对照组为77%,差异无统计学意义(P>0.05)。术后3个月,两组均有不同程度肛门失禁患者,治疗组患者肛门Wexner评分低于对照组,差异有统计学意义(P<0.05);肛门直肠动力指标:与术前比较,术后两组肛管最大收缩压值均无明显差异(P>0.05),治疗组术后直肠静息压[(1.29±0.31)kPa]、肛管静息压[(15.82±2.55)kPa]值与术前直肠静息压[(1.31±0.19)kPa]、肛管静息压[(16.45±1.81)kPa]差异无统计学意义(P>0.05),对照组术后直肠静息压[(0.92±0.22)kPa]、肛管静息压[(12.03±1.81)kPa]较术前直肠静息压[(1.34±0.31)kPa]、肛管静息压[(17.04±1.12)kPa]均显著下降,且术后对照组直肠静息压、肛管静息压值明显低于治疗组,差异有统计学意义(P<0.05)。结论:与传统挂线疗法比较,松紧结合挂线能更好的保护高位肛瘘患者术后肛门功能结构和功能,降低肛门失禁的发生率。
关键词:  松紧结合挂线  高位肛瘘  肛门功能  肛门直肠压力
DOI:10.3969/j.issn.1007-6948.2021.02.026
投稿时间:2020-07-03
基金项目:湖南省技术创新引导计划临床医疗技术创新引导项目(2017SK50305);湖南省中医药管理局项目基金(201878);湖南省浏阳市中医医院重点科研资助项目(LY2017A03)
Impacts of Loose Thread-drawing Combined with Tight Thread-drawing on Anal Function and the Changes of Anorectal Pressure in the Treatment of High Anal Fistula
TAN Jin-zhi,XIAO Wan-qing,ZHAN Ben-long
Abstract:
Objective To compare the effects of elasticity combined with hanging thread and traditional hanging thread therapy on Wexner score and anorectal dynamics of postoperative anal function in patients with high anal fistula. Methods Sixty patients of high anal fistula were randomized into a control group and a treatment group, which 30 cases in each one. In the control group, the traditional thread-drawing was applied, while in the treatment group, the loose thread-drawing combined with tight thread-drawing was used. The total clinical therapeutic effects, Wexner score and the changes of anorectal dynamic indicators which included AMCP (Anal Maximal Contraction Pressure, AMCP), ARP (Anal Rest Pressure, ARP) and RRP (Rectal Rest Pressure, RRP) were compared between the two groups. Results The overall effective rate of the postoperative treatment group was 80%, and the control group was 77%, which the difference was not statistically significant (P>0.05). Postoperative treatment group Wexner score (1.10±3.16) was significantly lower than that of the control group (2.97±4.60) (P<0.05). Anorectal motility index: compared with before treatment, there was no significant difference in AMCP values between the two groups after treatment (P>0.05). The RRP [(1.29±0.31) kPa], ARP [( 15 . 82 ±2 . 55 ) kPa] values of the treatment group were lower than those of the RRP [(1.31 ±0 . 19 ) kPa], ARP [( 16 . 45±1 . 81 ) kPa] before treatment, which the difference was not statistically significant (P > 0 . 05 ). The RRP [(0.92 ±0 . 22 ) kPa], ARP [( 12 . 03±1 . 81 ) kPa] of the control group were significantly lower than those of the RRP [(1.34±0.31) kPa], ARP [(17.04±1.12) kPa] values before treatment (P<0.05). The RRP and ARP values of the treatment group after treatment were significantly lower than those of the control group (P<0.05).  Conclusion Compared with traditional thread-hanging therapy, elasticity combined with thread-hanging can protect the postoperative anal functional structure and function of patients with high anal ?stula better, thereby
Key words:  Tighten elastic thread  high anal ?stula  anal function  anorectal pressure

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