挂线疗法治疗高位肛瘘技术参数的临床研究

Clinical Study on the Technical Parameters of Cutting Seton Therapy for High Anal Fistula

目的解决挂线疗法操作过程中的量化问题,对这种具有中医优势的手术方法进行规范化研究。方法共观察病例45例,均行低位切开高位挂线手术,依据挂线勒割肌束收紧长度分为1/4组、1/3组、1/2组,每组15例。以皮筋脱落时间、创面面积、视觉模拟疼痛评分、愈合时间、术前与痊愈后肛门直肠压力变化情况及Wexner失禁评分为指标进行观察对比。结果 3组均100%短期痊愈,1/4组和1/2组2个月复发率均为6.67%(1/15),1/3组为0,在治疗总疗效及2个月复发情况方面差异无统计学意义。视觉模拟疼痛评分,第1日疼痛评分3组平均相差1分(10分为最痛),1/4组疼痛较轻,1/2组疼痛较重,两两比较差别均有统计学意义。皮筋脱落距手术日天数,1/4组脱落最慢,平均(18.00±0.56)d,1/3组平均(13.73±0.23)d,1/2组脱落最快,平均(10.27±0.78)d。愈合时间,1/4组愈合天数调整均数为(34.13±0.89)d,1/3组为(28.54±0.88)d,1/2组为(30.73±0.89)d。3组两两比较差异均有统计学意义。结论 1/4组及1/3组是较理想的挂线方案,对肛门功能保护较好,疼痛较轻,复发率低。本研究设计的带刻度的橡皮筋应用于挂线疗法操作简便,安全可靠。

Objective To study the standardization of seton therapy which has advantages of traditional Chinese medicine, and to achieve the quantized process of operating cutting seton. Methods Forty-five examples diagnosed as high anal fistula were divided into 1/4, 1/3 amd 1/2 group stochastically according to seton tightness degree. Every group had 15 examples and adopt the traditional low-position incision and high-position cutting seton therapy in all cases. The duration with the seton in place, the time of the wound healing, VAS score, anus-rectum pressure and Wexner score of the three groups were observed and compared. Results Cure rate of three groups were all 100%. Three groups in the aspect of the total curative effect, two-month recrudescence situation had no significant difference （P 〉0.05）. As to VAS score of the first day after operation, the difference between the three group was 1 score, compared between any two groups. The mean duration with the seton in place was （18.00±0.56） days in 1/4 group, （13.73_±0.23） days in 1/3 group, （10.27±0.78） days in 1/2 group. The mean time of the wound healing was （34.13±0.89） days in 1/4 group, and （28.54±0.88） days in 1/3 group, （30.73±0.89） days in 1/2 group, with significant difference compared between any two groups （P 〈0.05）. Conclusion Tightening the seton 1/4 or 1/3 of the tissues＇ girth is better operative methods, which could less effect on function of the anal sphincter, and decrease recurrence rate. The elastic loop with scales we designed is easy to use, which ensure the safety of the difficult surgery.