括约肌保存术治疗单纯性高位肛瘘的研究

Treatment for high simple anal fistula with sphincter-preserving fistulectomy

目的:探讨应用括约肌保存术治疗单纯性高位肛瘘的效果。方法:对2000年9月至2006年7月收治的112例单纯性高位肛瘘病人,随机分别行括约肌保存肛瘘切除术与挂线疗法。评估和比较术后复发与括约肌功能受损程度。肛门控便功能采用肛门失禁严重度指数(FISI)评价。结果:括约肌保存术组术后平均愈合时间显著短于挂线疗法组(P<0.01),其术后复发率(1.69%)显著性低于挂线疗法组(13.21%)(P<0.05)。括约肌保存术组术后1年时的平均FISI值为6.3,挂线疗法组为13.1,存在显著性差异(P<0.01)。括约肌保存术组无FISI>30的病人,而挂线疗法组FISI>30者占7.55%,二者有显著性差异(P<0.01)。结论:肛瘘切除术保存括约肌较挂线疗法疗程短、复发率低、对控便功能损伤小,是高位单纯性肛瘘治疗的可行选择。

Objective To study the effect of sphincter-preserving fistulectomy in the treatment of high simple anal fistula. Methods A total of 112 cases of high simple anal fistula were studied, of which 59 cases were treated by sphincter-preserving fistulectomy （Groupl）, 53 cases by cutting seton technique （Group2）. Results The healing time of Groupl was （12±2） d, significantly shorter than that of Group2 [（20±3） d]（P〈0.01）. Groupl had a recurrence rate of 1.69%, significantly lower than that of Group2（13.21%）（P〈0.05）. The mean Fecal Incontinence Severity Index（FISI） of the 2 groups were 6.3 and 13.1 respectively, with a significant statistical difference（P〈0.01）. There was no case with FISI〉30 in Groupl （0%）, while 4 cases（7.55%） had FISI〉30 in Group2（P〈0.05）. Conclusions In the treatment of high simple anal fistula, sphincter-preserving fistulectomy offers rapid healing, low recurrence and good functional outcome for fecal control; it could be accepted as a preferrable method for the disease entity.