经直肠推移瓣术联合括约肌间瘘结扎术治疗高位单纯型肛瘘的临床疗效观察

Clinical observation on the treatment of high simple anal fistula with endorectal advancement flap combined with ligation of the intersphincteric fistula tract

目的探讨经直肠推移瓣术(endorectal advancement flap,ERAF)联合括约肌间瘘结扎术(ligation of the intersphincteric fistula tract,LIFT)治疗高位单纯型肛瘘的临床疗效。方法选取2022年3—9月北京市肛肠医院(北京市二龙路医院)高位单纯型肛瘘住院患者84例,按照随机数字表法分为观察组和对照组,每组42例。观察组采用ERAF联合LIFT,对照组采用传统切除挂线术。比较治疗后两组视觉模拟评分(visual analogue scale,VAS)、临床疗效及并发症情况。结果84例患者中,男58例、女26例,年龄27~59岁,平均(32.6±6.8)岁。观察组术后第1天、第3天、第7天的VAS低于对照组[(5.24±1.08)分比(7.19±1.35)分,(4.76±1.11)分比(6.21±1.09)分,(2.34±0.54)分比(2.98±0.61)分],出血量、住院时间及伤口愈合时间低于对照组[(7.83±1.62)ml比(12.66±2.46)ml,(3.75±1.66)d比(4.55±1.71)d,(28.15±8.65)d比(39.12±10.23)d],术后2个月Wexner评分及肛管收缩压低于对照组[(3.28±0.63)分比(4.46±0.75)分,(178.49±8.82)mmHg比(186.22±10.29)mmHg,1 mmHg=0.133 kPa],肛管静息压高于对照组[(45.88±2.87)mmHg比(43.85±1.74)mmHg],并发症发生率低于对照组(11.90%比33.33%),差异均有统计学意义(P<0.05);两组手术时间的比较,差异无统计学意义(P>0.05)。结论相较于传统肛瘘切除挂线术,ERAF联合LIFT具有患者出血量少、痛苦小、病程短、恢复快等优点,值得临床推广。

Objective To explore the clinical efficacy of endorectal advancement flap(ERAF)combined with ligation of the intersphincteric fistula tract(LIFT)in the treatment of high simple anal fistula.Methods A total of 84 patients with high simple anal fistula in Beijing Anorectal Hospital(Beijing Erlong Road Hospital)from March to September 2022 were selected,and were randomly divided into the observation group and the control group,with 42 patients in each group.The observation group was treated with ERAF combined with LIFT,while the control group was treated with traditional incision and thread-drawing surgery.The visual analogue scale(VAS),clinical efficacy and complications were compared between the two groups.Results Among the 84 patients,there were 58 males and 26 females,aged from 27 to 59 years,with an average of(32.6±6.8)years.The VAS of the observation group on the 1st,3rd and 7th day after operation was lower than those of the control group[(5.24±1.08)score vs.(7.19±1.35)score,(4.76±1.11)score vs.(6.21±1.09)score,(2.34±0.54)score vs.(2.98±0.61)score],the blood loss,hospitalization time and wound healing time were lower than those in the control group[(7.83±1.62)ml vs.(12.66±2.46)ml,(3.75±1.66)d vs.(4.55±1.71)d,(28.15±8.65)d vs.(39.12±10.23)d],Wexner score and anal systolic blood pressure two month after operation were lower than those in the control group[(3.28±0.63)score vs.(4.46±0.75)score,(178.49±8.82)mmHg vs.(186.22±10.29)mmHg,1 mmHg=0.133 kPa],the anal resting pressure was higher than that in the control group[(45.88±2.87)mmHg vs.(43.85±1.74)mmHg],and incidence of complications were lower than that of the control group(11.90%vs.33.33%),the differences were statistically significant(all P<0.05).There was no significant difference in operation time between the two groups(P>0.05).Conclusions Compared with the traditional incision and thread-drawing surgery for high simple anal fistula,ERAF combined with LIFT has an advantage of less bleeding,less pain,shorter course of disease,faster recovery,which is worthy of clinical promotion.