摘要
AIM:To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess.METHODS:Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression(SDPC)] and control group [fistulotomy(FSLT)].In the SDPC group,the internal opening was excised and incisions at external openings were made for drainage.Silk sutures were put through every two incisions and knotted in loose state.The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge.In the FSLT group,the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed.The time of healing,postoperative pain score(visual analogue scale),recurrence rate,patient satisfaction,incontinence evaluation and anorectal manometry before and after the treatment were examined.RESULTS:There were no significant differences between the two groups regarding age,gender and fistulae type.The time of healing was significantly shorter(24.33 d in SDPC vs 31.57 d in FSLT,P < 0.01) and the patient satisfaction score at 1 mo postoperative followup was significantly higher in the SDPC group(4.07 in SDPC vs 3.37 in FSLT,P < 0.05).The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT.None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively.The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and transsphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ± 1.35 in FSLT.The maximal squeeze pressure and resting pressure declined after treatment in both groups.The maximal anal squeeze pressures after treatment were reduced(23.17 ± 3.73 Kpa in SDPC vs 22.74 ± 4.47 Kpa in FSLT) and so did the resting pressures(12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT),but there were neither significant differences between the two groups and nor significant differences before or after treatment.CONCLUSION:Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and abscess is safe,effective and less invasive.
AIM： TO evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with sec- ondary tracks and abscess. METHODS： Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression （SDPC）] and control group [fistulotomy （FSLT）]. In the SDPC group, the internal opening was excised and incisions at ex- ternal openings were made for drainage. Silk sutures were put through every two incisions and knotted in loose state. The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge. In the FSLT group, the internal opening and all tracts were laid open and cleaned by normal saline postop- eratively till all wounds healed. The time of healing, postoperative pain score （visual analogue scale）, re- currence rate, patient satisfaction, incontinence evalu- ation and anorectal manometry before and after the treatment were examined. RESULTS： There were no significant differences be- tween the two groups regarding age, gender and fistu- lae type. The time of healing was significantly shorter （24.33 d in SDPC vs 31.57 d in FSLT, P 〈 0.01） and the patient satisfaction score at 1 mo postoperative follow- up was significantly higher in the SDPC group （4.07 in SDPC vs 3.37 in FSLT, P 〈 0.05）. The mean maximal postoperative pain scores were 5.83±2.5 in SDPC vs 6.37±2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT. None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively. The Wexner score after treatment of intersphincter fistulae were 0.17± 0.41 in SDPC vs 0.40±0.89 in FSLT and trans- sphincter fistulae were 0.13±0.45 in SDPC vs 0.56± 1.35 in FSLT. The maximal squeeze pressure and rest- ing pressure declined after treatment in both groups. The maximal anal squeeze pressures after treatment were reduced （23.17 ± 3.73 Kpa in SDPC vs 22.74 ± 4.47 Kpa in FSLT） and so did the resting pressures （12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT）, but there were neither significant differences between the two groups and nor significant differences before or after treatment. CONCLUSION： Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and ab- scess is safe, effective and less invasive.
基金
Supported by Grants from Chinese Ministry of Education,No. 210077 and No.20093107110005
Shanghai Municipal Education Commission,No.10ZZ77
Shanghai Science and Technology Commission,No.10QA1406600
