文章摘要

肛瘘切开挂线术联合置管冲洗术与切开挂线术治疗高位复杂性肛瘘的临床研究

作者: 1邱国军, 1牟伟纲, 1孙铁峰
1 青岛市第八人民医院急诊外科,青岛 266000
通讯: 邱国军 Email: 835474925@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.09.030

摘要

目的:探讨肛瘘切开挂线术联合置管冲洗术与传统切开挂线术治疗高位复杂性肛瘘的手术效果。方法:共选取符合研究标准的186例高位复杂性肛瘘,采用随机数表法分为对照组(n=93)和观察组(n=93)。对照组行传统切开挂线术治疗,观察组行肛瘘切开挂线术联合置管冲洗术治疗,比较两组手术相关指标、手术并发症和住院费用,术后随访3个月比较两组肛门功能及复发率。结果:观察组术后7 d视觉模拟疼痛评分(Visual Analogue Scale,VAS)评分、住院费用显著低于对照组,创面愈合和住院天数短于对照组,差异有统计学意义(t=3.095,6.099,6.454,5.572,P<0.05);两组术后3个月肛管静息压(anal resting pressure,ARP)、肛管最大收缩压(anal maximal contraction pressure,AMCP)、Wexner评分较术前均有显著下降,差异有统计学意义(P<0.05),观察组术后3个月ARP,AMCP显著高于对照组,Wexner评分低于对照组,差异有统计学意义(t=2.563,4.281,9.149,均P<0.05)。观察组并发症率4.30%,无肛瘘复发病例,对照组并发症率12.90%,复发率4.30%,组间并发症率比较差异有统计学意义(χ2=4.377,P<0.05)。结论:肛瘘切开挂线术联合置管冲洗术治疗高位复杂性肛瘘效果显著,在减轻手术疼痛、促进术后康复、降低经济负担和改善预后方面优于常规切开挂线术。
关键词: 高位复杂性肛瘘;挂线疗法;肛瘘切开挂线术;置管冲洗术;愈合;肛门功能;复发

Clinical study on the treatment of high complex anal fistula with incision and thread drawing of anal fistula combined with tube washing and incision and thread drawing

Authors: 1QIU Guojun, 1MOU Weigang, 1SUN Tiefeng
1 Department of Emergency Surgery, the Eighth People’s Hospital of Qingdao, Qingdao 266000, China

CorrespondingAuthor: QIU Guojun Email: 835474925@qq.com

Abstract

Objective: To investigate the effect of incision and thread-drawing of anal fistula combined with catheter irrigation and traditional incision and thread-drawing in the treatment of high complex anal fistula. Methods: A total of 186 cases of high complex anal fistula were selected and randomly divided into control group (n=93) and observation group (n=93). The control group was treated with traditional incision and thread-hanging operation, while the observation group was treated with anal fistula incision and thread-hanging operation combined with catheter irrigation. The related indexes, complications and hospitalization costs of the two groups were compared. The anal function and recurrence rate of the two groups were compared after 3 months of follow-up. Results: The Visual Analogue Scale (VAS) score and hospitalization expenses of the observation group were significantly lower than those of the control group at 7 days after operation, and the wound healing and hospitalization days were shorter than those of the control group (t=3.095, 6.099, 6.454, 5.572, P<0.05); the anal resting pressure (ARP), anal maximal contraction pressure (AMCP) and Wexner scores of the two groups at 3 months after operation were significantly lower than those of the control group (P<0.05). The ARP and AMCP of the observation group at 3 months after operation were significantly higher than those of the control group, and Wexner scores were lower than those of the control group (t=2.563, 4.281, 9.149, P<0.05). In the observation group, the complication rate was 4.30%, and there was no recurrence of anal fistula. In the control group, the complication rate was 12.90%, and the recurrence rate was 4.30%. There was significant difference in the rate of complications between groups (χ2=4.377, P<0.05). Conclusion: Anal fistula incision and thread-drawing combined with catheter irrigation has significant effect in the treatment of high complex anal fistula. It is superior to conventional incision and thread-drawing in alleviating operation pain, promoting post-operative rehabilitation, reducing economic burden and improving prognosis.
Keywords: high complex anal fistula; thread-drawing therapy; incision and thread-drawing of anal fistula; catheter irrigation; healing; anal function; recurrence