2种手术方式治疗高位肛瘘的疗效比较

A comparison of therapeutic effects of incision and thread-drawing technique via incision and thread-drawing technique plus selective suture in the treatment of high anal fistula

目的比较切开挂线选择性缝合术与切开挂线治疗高位复杂性肛瘘的临床疗效,探讨治疗高位肛瘘较为可靠有效的手术方法。方法选择2010年10月—2014年10月在淮南市第一人民医院治疗的高位复杂性肛瘘患者60例,采用数字表法随机分为2组,观察组(30例)采用切开挂线选择性缝合术治疗,对照组(30例)采用切开挂线治疗,比较2组治愈时间、治愈率、肛门功能评分及并发症发生情况。结果观察组治愈时间为(22±4)d,对照组治愈时间为(24±5)d,2组治愈时间比较差异有统计学意义(t=3.240,P<0.01);观察组治愈率为96.7%,对照组治愈率为86.7%,2组治愈率比较差异有统计学意义(χ2=3.857,P<0.05);观察组术后肛门功能评分为(4.8±1.2)分,对照组术后肛门功能评分为(6.8±1.3)分,2组术后肛门功能评分比较差异有统计学意义(t=2.671,P<0.01);随访半年,对照组复发4例,观察组无复发,2组均无肛门失禁者。结论切开挂线选择性缝合术与切开挂线均可有效治疗高位复杂性肛瘘,与切开挂线比较,切开挂线选择性缝合术治疗高位肛瘘治愈时间短、治愈率高、肛门功能恢复好,是治疗高位肛瘘较好的手术方法之一。肛瘘管道切除缝合加肛瘘主管挂线法用于高位复杂性肛瘘的治疗可获得较好的效果。

Objective To compare the clinical efficacy of incision and thread-drawing technique via incision and thread- drawing technique plus selective suture in the treatment of high anal fistula, and explore the effective and reliable surgical methods for high anal fistula. Methods Total 60 patients with high complex anal fistula were randomly assigned into two groups by number table method. The observation group（n = 30） received the incision and thread-drawing technique plus selective suture, while the control group（ n--30） received incision and thread-drawing therapy. The healing time, curative rate, anal function score and incidence of complications were compared between the two groups. Results The healing time of the observation group was （22 ± 4） d, of the control group was （24 ± 5） d, the difference was statistically signifi- cant（t = 3. 240,P 〈 0.01 ）. The follow up of six months showed that the curative rate in the observation group was 96.7 % , and in the control group was 86.7 % , the difference was statistical significance （ x^2 = 3. 857, P 〈 0.05 ）. The post- operative anal function score in the observation group was 4.8 ± 1.2, and in the control group was 6.8 ± 1.3, and differ- ence was statistically significant（ t = 2.671, P 〈 0.01 ）. The follow up of six months showed that there were 4 recurrence cases in the control group and 0 in the observation group, and there was no anal incontinence in both groups. Conclusion Both incision and thread-drawing technique via incision and thread-drawing technique plus selective suture are effective in the treatment of high anal fistula. The incision and thread-drawing technique plus selective suture shows more advantage in the healing time, curative rate and postoperative anal function as compared with incision and thread- drawing technique,which is a better method for high anal fistula.