| 摘要: |
| 目的:探讨虚实结合挂线法治疗高位肛瘘的临床疗效。方法:选取2017 年1 月—2019 年3 月在南京中医药大学沭阳附属医院肛肠科收治的90 例高位肛瘘患者，按随机数字表法分为治疗组与对照组，每组45 例。治疗组采用虚实结合挂线法治疗，对照组采用肛瘘切开挂线术治疗。比较两组患者治疗后的临床疗效、术后疼痛评分(VAS)、创面愈合时间、肛门功能评估(Wexner 评分)、肛管静息压及最大收缩压的变化情况。结果:治疗组的临床总有效率为97.8%，高于对照组的84.4%，差异有统计学意义(χ2=4.939, P=0.026) ；术后第1 天，治疗组的疼痛VAS 评分为(5.47±0.51)分，与对照组(5.53±0.57)分差异无统计学意义(t =0.526, P =0.600)；第7、10、14 天，治疗组的疼痛VAS 评分分别为(5.28±0.52、4.47±0.67、2.94±0.50)分，优于对照组(5.81±1.53、4.81±0.69、3.22±0.32)分，差异有统计学意义(t=2.200、2.389、3.164，P=0.032、0.019、0.002)；治疗组的创面愈合时间为(28.33±2.09 )d，优于对照组的(46.19±1.97) d，差异有统计学意义(t =41.715, P ＜ 0.001)；治疗组的术后肛门功能Wexner 评分(0.76±0.69)分显著优于对照组(2.83±0.42)分(t =17.19, P ＜ 0.001)；治疗前肛管静息压及最大收缩压治疗组(7.08±0.14、21.39±1.89) kPa，对照组(7.11±0.28、21.65±1.55) kPa，差异无统计学意义(t =0.623、0.714, P =0.523、0.478)，治疗后肛管静息压及最大收缩压治疗组(6.93±0.50、20.96±1.36) kPa，对照组(6.60±0.29、20.10±0.57)kPa，差异有统计学意义(t =2.785、3.821, P =0.007，P ＜ 0.001)。结论:采用虚实结合挂线法治疗高位肛瘘, 具有肛门功能保护好，痛苦小，恢复快，术式简单，操作性强等特点。 |
| 关键词: 高位肛瘘 虚实挂线法 肛门功能 |
| DOI：10.3969/j.issn.1007-6948.2020.06.025 |
| 投稿时间：2020-04-21 |
| 基金项目:宿迁市指导性科技计划项目(Z2018018) |
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| Analysis of Clinical Effect of Combination of Virtual and Solid with Hanging Thread in Treatment of High Anal Fistula |
| ZHONG Chao-xiang,ZHANG Qiong,HAN Jing |
| Department of Anorectal Surgery, Shuyang Hospital, Nanjing University of Traditional Chinese Medicine, Shuyang 223600, China |
| Abstract: |
| Objective To explore the clinical effect of the combination of virtual and solid with hanging line in the treatment of high anal fistula. Methods A total of 90 patients with high anal fistula were divided into treatment group and control group according to the random number table method, which 45 cases each.The treatment group was treated by the combination of virtual and solid suture, while the control group was treated by anal fistula incision and suture. Efficacy evaluation, postoperative pain score (VAS), wound healing time,anal function assessment (Wexner score), changes in anal resting pressure and maximum systolic pressure were performed after the two groups received relevant treatment to make a comparison of efficacy. Results The total effective rate was 97.8% in the treatment group and 84.4% in the control group, which the difference was statistically significant (χ2=4.939, P =0.026). Postoperative VAS score was (5.47±0.51) in the treatment group and (5.53±0.57) in the control group on the 1st day, showing no statistically significant difference (t =0.526,P =0.600).Treatment group (5.28±0.52, 4.47±0.67, 2.94±0.50) scores on the 7th, 10th,and 14th day, which were better than those of control group (5.81±1.53, 4.81±0.69, 3.22±0.32) scores (t =2.200, 2.389, 3.164,P =0.032, 0.019, 0.002). Treatment group wound healing time (28.33+2.09) is better than that of the control group (46.19+1.97) days (t=41.715, P <0. 001). Postoperative anal function Wexner score showed that the treatment group (0.76±0.69) score was significantly better than that of the control group (2.83±0.42)score (t =17.19, P <0.001). Before treatment, the anal repose pressure and maximum systolic pressure in the treatment group were (7.08±0.14, 21.39±1.89) kPa, while in the control group (7.11±0.28, 21.65±1.55) kPa, and the comparison showed no statistical signi?cance (t=0.623, 0.714, P=0.523, 0.478). After treatment, the anal resting pressure and the maximum systolic pressure in the treatment group were (6.93±0.50, 20.96 ±1.36) kPa and the control group were (6.60±0.29, 20.10 ±0.57) kPa. The comparison was statistically signi?cant (t=2.785, 3.821, P=0.007, P<0.001). Conclusion The combination of virtual and solid with hanging thread in the treatment of high anal ?stula has the characteristics of good anal function protection, less pain, quick recovery, simple operation and strong operability. |
| Key words: High anal ?stula virtual and solid hanging line method anus function |
