切挂选择缝合术治疗高位复杂性肛瘘临床及实验研究

Clinical and Experimentation Study of Treatment of High Complex Fistula-in-Ano by Using Incision Cutting Setion Drainage and Selective Suture

目的 :提高高位复杂性肛瘘的治疗效果 ,减少复发率 ,保护肛门括约肌 ,保护肛门感觉和自制功能。方法 :设计一种具有中西医结合特色的“切开、挂线、选择性缝合”术式治疗高位复杂性肛瘘 ,按全国高位复杂性肛瘘诊断标准及排除标准纳入病例 168例。随机分为 :观察组 86例用“切开、挂线、选择性缝合”术式 ,对照组 82例用切开挂线开放引流术。两组病例均于术前和术后 6个月随访期内用直肠灌注法检测直肠感觉和肛门节制功能。结果 :经术后和术后 6个月随访期的观察 ,观察组 86例全部一次性治愈 ,一次性治愈率 10 0 % ,随访期内 1(1 16% )例出现污染内裤 ,余未发现明显并发症及后遗症 ,肛门功能良好。平均疗程 2 6± 2 8天 ;对照组一次性治愈 69例 ,一次性治愈率 84 15 % ,13 (15 9% )例经 2次手术治疗 ,随访期内 1(1 2 % )例复发 ,术后肛门皮肤缺损 8例 (9 8% ) ,稀便失禁 2例 (2 44 % ) ,污染内裤 11例 (13 41% ) ,平均疗程 3 8± 6 7天。直肠感觉和肛门节制功能检测结果 :两组术前比较 ,P >0 0 5 ;试验组术前术后比较 ,P >0 0 5 ;两组术后比较 ,P <0 0 5 ;对照组术前术后比较 ,P <0 0 5。结论 :与对照组相比 ,本疗法具有疗效好 ,痛苦小 ,疗程短 ,对直肠感觉和肛门节制功能损伤小 。

Objective :The research aim of operation of high complex fistula-in-ano is to raise cure rate and to protect the anal functions,we also want to reduce the recurrence rate and to reduce the postoperative complication,to defend the sphincteric continence. Methods :86 cases patients in the study group,82 cases patients in the control group.The study group operation is a self-design operation by using incision cutting setion drainage and selective suture,the control group method by using incision,thread-drawing drainage.Test the rectal fluid sensory and anal continence function by method of clysising. Results :The cure rate of the study group is 100 percent,the par times of care are 26±2 8 days,have no after effect and complication;the cure rate of the control group is 84 15 percent,the par times of care are 38±6 7 days.The happening rate of after effect and complication is 25 61 percent.Test the rectal fluid sensory and anal continence function by method of clysising show:comparring of postoperative about two groups, P <0 05;beforeoperative VS postoperative of the control group, P <0 05. Conclusions :Compared with the control group,the operative approach of incision,cutting setion and drainage,selective suture therapy of fistula-in-ano has great advantages of less surgical injury,shortening treatment course,raising cure rate and protecting the anal functions.