切挂选择缝合术治疗高位复杂性肛瘘临床随机多中心对照研究

A Random and Multi-center Study on the Treatment of High and Complex Anal Fistula by the Combined Procedure of Incision, Thread-Drawing and Selective Suture

为了探索提高高位复杂性肛瘘的临床疗效，减少复发率，保护肛门感觉和自制功能，采用切开、挂线、选择性缝合术式治疗高位复杂性肛瘘72例（试验组），采用切开挂线开放引流术72例（对照组）。两组均采用直肠灌注法检测直肠感觉和肛门节制功能。经术后6个月随访观察，试验组72例全部一次性治愈，治愈率100％，随访期内1例（1．4%）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（26±2．1）d；对照组一次性治愈60例，占83．3％，其余12例（16．7％）经二次切缝引流术治愈，随访期内1例（1．4％）复发，术后肛门皮肤缺损7例（9．7％），稀便失禁2例（2．8％），污染内裤10例（13．9％），平均疗程（88±6．7）d。直肠感觉和肛门节制功能检测结果，试验组优于对照组。结果表明，切开、挂线、选择性缝合法治疗高位复杂性肛瘘具有疗效好，痛苦小，疗程短，对直肠感觉和肛门节制功能损伤小，并发症和后遗症少等优点。

The objective of this study was to raise the therapeutic outcome,reduce the recurrence rate and protect the anal function. Seventy two patients with high and complex anal fistula underwent the combined procedure of incision, thread-drawing and selective suture（the trial group） ,while another seventy two cases underwent the procedure of incision, thread-drawing and open drainage（the controlled group）. The rectal sense and anal controlling function were detected by rectal perfusion for all the cases in the two groups. Follow-up of six monthes showed that the primary cure rate in the trial group was 100%,and no complications and sequelae except one case with underpants contamination were found,and anal functions were well preserved. The mean treatment course in the trial group was （26 ± 2. 1） days. While in the controlled group,the primary cure rate was 83.3%（60/72） and the left twelve cases were cured by the second openation;recurrence was found in one case （1. 4%）, postoperative defect of anal skin was found in 7 cases （9.7%）,incontinence of thin stool was found in 2 cases（2.8%）,underpants contamination were found in 10 cases（13.9%） and the mean treatment course was （38±6. 7）days. Results revealed that the rectal sense and anal continence function in the trial group are better than those in the controlled group. It is concluded that the combined procedure of incision,thread-drawing and selective suture is a better and optimal one in the treatment of high and complex anal fistula.