纵切横缝内括约肌切断术治疗老年肛裂的效果

Effect of internal sphincterotomy of longitudinal incision and transverse suture on senile patients with anal fissure

目的分析纵切横缝内括约肌切断术治疗老年肛裂患者的效果。方法回顾性分析南阳市中心医院2019年12月至2021年4月收治的93例老年肛裂患者的临床资料。依照手术方案分为对照组(n=45)与观察组(n=48)。对照组接受开放式侧位肛裂切除术治疗,观察组接受纵切横缝内括约肌切断术治疗。比较两组临床效果、手术及恢复情况、炎性应激、创伤应激指标及并发症发生情况。结果治疗后,观察组治疗总有效率(97.92%,47/48)较对照组(77.78%,35/45)高,差异有统计学意义(χ^(2)=9.032,P=0.003<0.05)。与对照组相比,观察组手术时间、切口愈合时间、住院时间均较短,术中出血量较少(P<0.05)。与术前相比,两组术后1 d血清白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平均升高,但观察组低于对照组(P<0.05)。与术前相比,两组术后1 d血清皮质醇(Cor)、β内啡肽(β-EP)水平均升高,但观察组较对照组低(P<0.05)。观察组并发症发生率(4.17%,2/48)低于对照组(20.00%,9/45),差异有统计学意义(χ^(2)=5.583,P=0.018<0.05)。结论纵切横缝内括约肌切断术治疗老年肛裂患者效果显著,能有效缩短手术时间、愈合时间及住院时间,减少出血及并发症发生情况,且对机体炎性应激、创伤应激影响小。

Objective To analyze the effect of internal sphincterotomy of longitudinal incision and transverse sutre on elderly patients with anal fissure.Methods The clinical data of 93 elderly patients with anal fissure admitted to Nanyang Central Hospital from December 2019 to April 2021 were analyzed retrospectively.According to the operation plan,they were divided into control group(n=45)and observation group(n=48).The control group received open lateral anal fissure resection,and the observation group received longitudinal and transverse internal sphincterotomy.The clinical effect,operation and recovery,inflammatory stress.traumatic stress indexes and complications were compared between the two groups.Results After treatment,the total effective rate of treatment in the observation group(97.92%,47/48)was higher than that in the control group(77.78%,35/45),and the difference was significant(χ^(2)=9.032,P=0.003<0.05).Compared with the control group,the observation group has shorter operation time,wound healing time,hospital stay and less intraoperative bleeding(P<0.05).Compared with preoperative,the levels of serum interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in the two groups on the first day after operation increased,but the levels in the observation group were lower than those in the control group(P<0.05).Compared with preoperative,the levels of serum cortisol(Cor),β-endorphin(β-EP)in the two groups on the first day after operation all increased,but the levels in the observation group were lower than those in the control group(P<0.05).The incidence of complications in the observation group(4.17%,2/48)was lower than that in the control group(20.00%,9/45),and the difference was significant(χ^(2)=5.583,P=0.018<0.05).Conclusions Longitudinal transversal internal sphincterotomy has significant effects on anal fissure in elderly,which can effectively shorten operation time,healing time and hospital stay,reduce bleeding and complications,and has little effect on inflammatory stress and traumatic stress of the body.