摘要
目的:探究对切松紧高挂术治疗对高位复杂性肛瘘(complex anal fistula,CAF)患者白细胞介素-6(IL-6),白细胞介素-17(IL-17)水平及创面愈合时间的影响。方法:回顾性分析本院于2021年1月至2023年10月期间收治的行手术治疗的130例高位CAF患者的临床资料,依据手术方式差异将研究对象分为对切组(行对切松紧高挂术治疗,n=68)和传统组(行传统切开挂线术治疗,n=62)。比较对切组和传统组治疗效果,术后创面愈合情况,手术前与手术1周后创面症状评分、IL-6与IL-17水平,手术前与手术后3个月Wexner肛门失禁评分、肛门括约肌功能指标[肛管静息压(ARP)、肛管最大收缩压(AMCP)]水平,记录并发症发生情况。结果:对切组和传统组治疗总有效率(98.53%vs95.16%)差异无统计学意义(P>0.05);对切组术后创面愈合与住院时间短于传统组,创面愈合率高于传统组,差异具有统计学意义(P<0.05);术后1周两组创面症状评分均降低,且对切组降低幅度大于传统组,差异具有统计学意义(P<0.05);术后1周两组IL-6与IL-17水平均降低,且对切组降低幅度均大于传统组,差异均具有统计学意义(P<0.05);术后3个月两组Wexner肛门失禁评分、AMCP、ARP均下降,且对切组下降幅度均大于传统组,差异均具有统计学意义(P<0.05);对切组和传统组尿潴留发生率(1.47%vs3.23%)差异无统计学意义(P>0.05)。结论:对切松紧高挂术同传统术式都具备良好的治疗高位CAF效果,两种术式均具备较高安全性,能够有效减轻手术对肛门括约肌的影响。但与传统术式相比,对切松紧高挂术可显著性缩短创面愈合时间,加快创面相关症状恢复,下调机体炎症水平,有利于加快患者康复进程,可为治疗高位CAF的首选术式。
Objective:To explore the influence of contra-incision combined with high loose-tight thread on the levels of interleukin-6(IL-6)and interleukin-17(IL-17)and wound healing time in patients with high complex anal fistula(CAF).Methods:The clinical data of 130 patients with high CAF who received surgical treatment in the hospital were retrospectively analyzed from January 2021 to October 2023.According to the differences in surgical methods,the subjects were divided into contra-incision group(contra-incision combined with high loose-tight thread,n=68)and traditional group(traditional incision and thread-drawing,n=62).The therapeutic effect,postoperative wound healing status,wound symptoms scores and levels of IL-6 and IL-17 before surgery and at 1 week after surgery,Wexner anal incontinence score and anal sphincter function indexes[anal resting pressure(ARP),anal maximum contraction pressure(AMCP)]before surgery and at 3 months after surgery were compared between the contra-incision group and the traditional group,and the incidence of complications was recorded.Results:There was no statistical significance in the total effective rate of treatment between contra-incision group and traditional group(98.53%vs 95.16%)(P>0.05).Compared with the traditional group,the postoperative wound healing time and hospitalization time in the contra-incision group were shorter,and the wound healing rate was higher(P<0.05).At 1 week after surgery,the wound symptoms scores in both groups were reduced,and the reductions were greater in the contra-incision group(P<0.05).The levels of IL-6 and IL-17 were decreased in both groups at 1 week after surgery,and the decreases in the contra-incision group were greater compared to the traditional group(P<0.05).The Wexner anal incontinence score,AMCP and ARP at 3 months after surgery were declined in the two groups,and the declines in the contra-incision group were greater(P<0.05).No statistical difference was shown in the incidence of urinary retention between the contra-incision group and the traditional group(1.47%vs 3.23%)(P>0.05).Conclusion:Both contra-incision combined with high loose-tight thread and traditional surgery have good effects in the treatment of high CAF.Both the two methods have high safety and can effectively reduce the influence of surgery on the anal sphincter.However,compared with the traditional surgery,contra-incision combined with high loose-tight thread can more significantly shorten the wound healing time,accelerate the recovery of wound-related symptoms,and down-regulate the body’s inflammation level,and it is more conducive to accelerating the rehabilitation process of patients,and can be the first choice for the treatment of high CAF.
作者
谢永俊
穆永保
张雁
张明金
XIE Yongjun;MU Yongbao;ZHANG Yan(Joint Logistics Support Force 901 Hospital of Chinese People's Liberation Army,Anhui Hefei 230031,China)
出处
《河北医学》
CAS
2024年第12期2011-2016,共6页
Hebei Medicine
基金
国家自然科学基金资助项目,(编号:82274426)。
关键词
对切松紧高挂术
高位复杂性肛瘘
传统切开挂线术
创面愈合
炎症
Contra-incision combined with high loose-tight thread
High complex anal fistula
Traditional incision and thread-drawing
Wound healing
Inflammation
