两种术式治疗高位复杂性肛瘘的疗效对比

Comparison on the Therapeutic Effects of Two Procedure for High Complex Anal Fistula

为比较切开挂线引流术与内口修补、外口切开引流术治疗高位复杂性肛瘘的疗效，将50例高位复杂性肛瘘患者随机分为两组，各25例。一组行传统切开挂线引流术（A组），一组行内口修补、外口切开引流术（B组），对比观察两组患者临床疗效、创口愈合时间、术后肛门功能及复发情况。结果显示，A组手术治愈率（96．0％）明显高于B组（72．0％），P〈O．05；A组创面愈合时间[（42．5土4．9）d]明显长于B组[（30．2±5．6）d]，P〈O．05；A组2例患者肛门皮肤缺损，2例肛门控气功能下降，3例肛门溢液，B组无上述并发症。术后随访1年，A组无复发，B组复发7例，两组复发率比较差异有统计学意义，P〈0．05。结果表明，传统切开挂线引流术治疗高位复杂性肛瘘治愈率高、复发率低，疗效肯定，但创面愈合时间长，且术后易出现肛缘皮肤缺损、肛门控气功能下降及肛门溢液等情况；内口修补、外口切开引流术治疗高位复杂性肛瘘因减少了对肛门括约肌、肛周皮肤的破坏，可更确切地保护肛门功能，且创面愈合快，但治愈率及复发率方面不及传统切开挂线引流术，可能与术中皮瓣缝合技巧、术后护理、换药技术及患者配合程度要求相对较高有关。在技术逐渐改进的情况下，内口修补、外口切开引流术仍有很大的发展空间。

This study was to compare the therapeutic effects of two procedure,i, e incision thread-drawing drainage repair for inner-opening and incision drainage for exter-opening,in the treatment of high complex anal fistula. The 50 patients with this disease were randomly divided into group A and group B.group A re- ceived the former surgery, group B received the latter surgery then clinical effect, wound healing time, postoperative function of anus, and fistula recurrence in both groups were compared and observed. As re- sults, the curative rate, wound healing time of group A was significantly higher,longer than that of group B （96.0% vs 72.0if0, P %0.0542.5＋4.9d vs 30.2＋5.6d, P %0.05）in group A 2 cases suffered from skin defect of anus, 2 from decreased function of control flatus, 3 from anal polyrrhea, while in group B there was no above-mentioned complications;the postoperative follow-up of one yr. found in group B 7 ca- ses being recurrent, in group A no cases recurrent, thus there was statistical difference between both groups in recurrent rate. Results show that the former procedure is of high curative rate, low recurrent rate,and positive effect, but of long wound surface healing time, above-mentioned three complication easily occuring meanwhile the latter procedure owing to its reducing injuries of anal sphincter and perianal skin can practi- cally protect the function of anus,so that making wound surface healing faster,but its curative rate and re- current rate were inferior to the former procedure, which may be related to needing higher levels of intraop- erative flap suture skill, postoperative nursing and dressing change manipulation as well as patient＇s coordi- nate,but along with skill gradually improved the latter would be developed further.