摘要
目的分析经括约肌间引流挂线术、切割挂线术与肛门直肠瓣推移术治疗高位经括约肌肛瘘的临床效果。方法回顾性分析2013年7月至2016年7月在安徽医科大学第三附属医院肛肠科收治的41例高位经括约肌肛瘘患者临床资料,按照手术方式的不同,分为括约肌间引流挂线组(采用经括约肌间引流挂线术,n=15),切割挂线组(采用切割挂线术,n=16)与肛门直肠瓣推移组(采用经肛门直肠瓣推移术,n=10)。比较三组术后疼痛持续时间、切口愈合时间以及术后12个月治愈率,记录三组术后3个月Wexner评分,分析三组术前及术后3个月的肛管静息压(ARP)、肛管最大收缩压(AMSP)、直肠静息压(RRP)及直肠初始感觉阈值(IST),初始排便阈值(IDT)及最大感觉阈值(MST)。结果切割挂线组的术后疼痛持续时间及伤口愈合时间最长,术后3个月Wexner评分最高,肛门直肠瓣推移组术后12个月治愈率低于切割挂线组(均P<0.05),余两两组间比较差异均无统计学意义(均P>0.05)。三组间术前ARP、AMSP、RRP、IST、IDT及MST比较,差异均无统计学意义(均P>0.05)。三组术后ARP、AMSP、IST、IDT及MST较术前下降(均P<0.05),RRP与术前比较,差异均无统计学意义(均P>0.05)。术后,切割挂线组ARP、AMSP最低,切割挂线组术后IST、IDT及MST低于括约肌间引流挂线组,切割挂线组IST低于肛门直肠瓣推移组(均P<0.05),余两两组间比较差异均无统计学意义(均P>0.05)。结论相比于切割挂线术,保留肛门外括约肌的术式(经括约肌间引流挂线术或经肛门直肠瓣推移术)更有助于减轻高位经括约肌肛瘘患者术后疼痛,术后切口愈合时间较短,采用经括约肌间引流挂线术可同时获得较为理想的治愈率及术后肛门功能。
Objectives To investigate the effect of intersphincteric drainage and seton, traditional cutting seton, and transanal rectal advancement flap (TRAF) in treating transsphincteric anal fistula. Methods This was a retrospective analysis of 41 pa tients with high transsphincteric anal fistula who were treated at the Department of Coloproctology, the Third Affiliated Hospital of Anhui Medical University between July 2013 and July 2016. Patients were divided into three groups: intersphincteric drainage and seton group (n = 15), traditional cutting seton group (n = 16), and TRAF group (n = 10). The duration of postoperative pain, time to wound healing, and cure rate after 12 months were compared among the three groups. Wexner score was evaluated at 3 months after surgery. Anal resting pressure (ARP), anal maximum systolic pressure (AMSP), rectal resting pressure (RRP), initial sensory threshold (IST), initial defecation threshold (IDT), and maximum sensory threshold (MST) were recorded before and 3 months after surgery. Results The traditional cutting seton group had the longest duration of postoperative pain, the longest time to wound healing, and highest Wexner score at 3 months after surgery (P < 0.05). Cure rate was lower in the TRAF group compared with traditional cutting seton group at 12 months after surgery (P < 0.05). Difference of other pair-wise comparisons was not significant (P > 0.05). ARP, AMSP, RRP, IST, IDT, and MST were comparable among the groups before surgery (P > 0.05). ARP, AMSP, IST, IDT and MST decreased significantly after surgery (P < 0.05) in all groups except RRP (P > 0.05). The traditional cutting seton group had the lowest ARP and AMSP after surgery, it had significantly lower IST, IDT and MST than the intersphincteric drainage and seton group, and it also had significantly lower IST than the TRAF group (P < 0.05). Dif ference of other pair-wise comparisons was not significant (P > 0.05). Conclusion Compared with traditional cutting seton, the intersphincteric drainage and seton and TRAF procedure could reduce the postoperative pain, shorten the time to wound healing in patients with high transsphincteric anal fistula. Intersphincteric drainage and seton was associated with gratifying cure rate and postoperative anal function at the same time.
作者
刘远成
张劲远
朱竞
李永海
吕文辉
彭西兰
张承岳
Liu Yuancheng;Zhang Jingyuan;Zhu Jing;Li Yonghai;Lü Wenhui;Peng Xilan;Zhang Chengyue(Department of Coloproctology, The Third Affiliated Hospital of Anhui Medical University, Hefei 230061, Anhui, China)
出处
《结直肠肛门外科》
2019年第5期553-557,共5页
Journal of Colorectal & Anal Surgery
基金
合肥市卫生计生委中医药科研课题（编号2014中医专项）
关键词
高位经括约肌肛瘘
经括约肌间引流挂线术
切割挂线术
经肛门直肠瓣推移术
transsphincteric anal fistula
intersphincteric drainage and seton
traditional cutting seton
transanal rectal advancement flap
