肛门功能评估在高位复杂性肛瘘治疗中的价值

Anal functional evaluation in treatment of high complex anal fistula

目的探讨肛门功能评估在高位复杂性肛瘘治疗中的价值。方法对肛门功能评估的高位复杂性肛瘘患者72例，根据行肛瘘手术次数分别纳入0组、1组、2组、3组和4组。回顾性分析肛管直肠压力测定所得肛管静息压、肛管收缩压、肛管舒张压、括约肌功能长度、直肠肛门收缩反射、抑制反射和排便弛缓反射、直肠初始阈值及最大耐受量等指标，其中43例通过电话和门诊获得随访，平均随访时间（11．4±7．5）个月，比较术前和术后远期肛门失禁评分（Wexner法）。结果高位复杂性肛瘘患者肛管直肠压力测定的各项指标需要综合分析。四组患者肛管静息压、肛管收缩压、肛管舒张压比较差异均有统计学意义（P〈0．001），直肠肛管抑制反射异常率差异有统计学意义（P〈0．005），提示上述指标的降低及差异与手术次数有关。直肠肛管收缩反射和弛缓反射异常率及直肠感觉阈值差异无统计学意义（P〉0．05）。43例获得随访的患者Wexner评分入院时0～6分，平均（2．4±0．2）分；随访时0～10分，平均（4．9±1．2）分（P〈0．005）。结论应重视高位复杂性肛瘘患者的肛门功能评估，尤其是术前肛管直肠测压评估应得到推荐。

Objective To investigate the role of anal functional evaluation in treatment of high complex anal fistula. Methods Seventy - two patients with high complex anal fistula treated in our department during April 2000 to May 2006 were recruited in the study, including 67 men and 5 women with a mean age of 42 years （range 20 to 66 ）. Based on the fistula operation times the patients were divided into 5 groups：zero group （ n = 31 ）,first group （ n = 11 ）,second group （ n = 16）,third group （ n = 8） and fourth group （ n = 6）. The anal sphincter resting pressure, high pressure zone, maximal squeeze pressure, relaxation reflex, rectal - anal contract reflex, rectal - anal inhibitory reflex, sensory threshold and rectal maximal capacity were observed. Follow - up was 11.4 ± 7.5 months by outpatient and telephone questionnaire in 34 patients. The Wexner incontinence score was compared before and long term after operation. Results The parameter values measured by Manometry should be analyzed generally. Among 5 groups there was significant difference in anal sphincter resting pressure （ P 〈 0. 001 ）, maximal squeeze pressure （ P 〈 0. 001 ）,anal relax pressure （ P 〈 0. 001 ） and the rectal- anal inhibitory reflex （ P 〈 0. 005 ）, but there was significant difference in relaxation reflex and rectal- anal contract reflex （ P 〉 0.05 ）. In 34 patients subject to follow - up, the Wexner incontinence score was from o score to 6 scores （average score 2.4 ± 0.2） on the admission and from zero score to 10 scores （average score 4.9 ± 1.2） during follow - up. Conclusion Attention should be paid to the anal functional evaluation in high complex anal fistula, especially manometry before operation.