| 摘要: |
| 目的 观察括约肌间窗式减压瘘管激光闭合术、瘘管激光闭合术与肛瘘切除术治疗经括约肌肛瘘(Parks Ⅱ型肛瘘)的临床疗效。方法:将2021年1月—2022年12月上海市嘉定区中医医院肛肠科收治的132例Parks Ⅱ型肛瘘患者，分为治疗1组(瘘管激光闭合术组)、治疗2组(括约肌间窗式减压瘘管激光闭合术组)与对照组(瘘管切除术组)，每组44例。记录三组治愈时间、肛管直肠测压(治疗前、术后1个月及术后6个月)、术后症状及体征评分(手术即日、术后第1、3、7、14天对疼痛、发热、渗出、尿潴留进行评价)、临床疗效及复发率。结果:治疗2组伤口愈合时间最短，对照组最长；三组比较差异有统计学意义(P<0.001)。治疗后，三组肛管收缩压及肛管静息压较治疗前均有不同程度下降；与对照组比较，治疗1组与治疗2组肛管收缩压治疗前后差值差异均有统计学意义(P<0.01)，治疗2组与对照组肛管静息压治疗前后差值比较，差异有统计学意义(P<0.05)。手术即日、术后第1、3、7、14天三组发热、尿潴留评分比较差异均无统计学意义(P>0.05)；手术即日、术后第1、3、7天，与对照组比较，治疗1组与治疗2组渗出及疼痛评分，差异均有统计学意义(P<0.01)。三组总有效率比较差异无统计学意义(P>0.05)。术后6个月，三组均无复发病例。结论:括约肌间窗式减压瘘管激光闭合术是治疗Parks Ⅱ型肛瘘的有效术式，具有创伤小、术后疼痛轻、渗出少、愈合时间短等优势，是一种值得临床推广的保护括约肌术式。 |
| 关键词: 括约肌间窗式减压瘘管激光闭合术 瘘管激光闭合术 Parks Ⅱ型肛瘘 |
| DOI：10.3969/j.issn.1007-6948.2024.02.005 |
| 投稿时间：2023-10-12 |
| 基金项目:上海市嘉定区卫生健康委中医药科研课题项目(2020-KY-ZYY-03)；上海市嘉定区名老中医工作室(流派工作室)建设项目(2021MLZYGZS-04) |
|
| Clinical study on the treatment of parks II anal fistula with sphincter decompression filac |
| MIN Li，LI Yue，WAN Bo-shun |
|
| Abstract: |
| Objective To observe the clinical efficacy of fistula-tract laser closure decompression between sphincters, fistula-tract laser closure, and anal fistulectomy in the treatment of Parks II anal fistula. Methods A total of 132 Parks II anal fistula patients admitted to the Department of Anorectal at Jiading Traditional Chinese Medicine Hospital in Shanghai from January 2021 to December 2022 were randomly divided into treatment group 1 (fistula-tract laser closure group), treatment group 2 (sphincter decompression fistula-tract laser closure group), and control group (fistula resection group), with 44 patients in each group. The healing time, anorectal manometry (evaluation before treatment, 1 month after operation, and 6 months after operation), postoperative symptom and sign scores (evaluation of pain, fever, exudation, and urinary retention on the operation day, the1st, 3rd, 7th, and 14th day after operation), clinical efficacy, and recurrence rate were recorded in the three groups. Results The wound healing time of the treatment group 2 was the shortest, while the control group had the longest healing time. The difference among the three groups was statistically significant (P<0.001). After treatment, the systolic pressure and resting pressure of the anal canal in the three groups decreased to different degrees compared with before treatment. Compared with the control group, the difference between the treatment group 1 and the treatment group 2 was statistically significant (P<0.01), and the difference between the treatment group 2 and the control group was statistically significant (P<0.01). There were no significant differences in the scores of fever and urinary retention among the three groups at all observation periods (P>0.05). Compared with the control group, there were significant differences in exudation and pain scores between treatment group 1 and treatment group 2 (P<0.01) on operation day, 1st, 3rd and 7th days after operation. There was no statistically significant difference in the total effective rate among the three groups (P>0.05). Six months after surgery, there were no recurrent cases in all three groups. Conclusion Sphincter decompression fistula-tract laser closure is effective surgical method for treating Parks II anal fistula. This method has the advantages of minimal trauma, mild postoperative pain, less exudation, and short healing time, which is worthy of clinical promotion for the protection of sphincter. |
| Key words: Sphincter decompression FiLaC fistula-tract laser closure Parks II anal fistula |
