改良LIFT术和常规LIFT术治疗单纯性经括约肌型肛瘘的比较分析

Modified versus routine ligation of intersphincteric fistula tract in treatment of simple transsphincteric perianal fistula

目的比较改良LIFT术（经括约肌间瘘管结扎术）和常规LIFT术治疗单纯性经括约肌型肛瘘的临床疗效。方法2013年1月至2014年12月，86例单纯性经括约肌型肛瘘患者，随机分成A组和B组，分别接受改良LIFT术（A组）与常规LIFT术（B组）42例和44例。通过比较两组病例的手术时间、术后疼痛VAS评分、伤口愈合时间、住院时间及治愈率评估两种手术方法的临床疗效。所有随访患者于术后第3个月均测定肛门直肠压力和进行盆底肌电图检查以评估肛门功能。结果所有患者均获得随访3-26个月，平均（8．73±7．15）月。两组患者的手术时间、术后24h VAS疼痛评分和住院时间比较，差异均无统计学意义（P〉0．05）。两组患者的伤口愈合时间比较，差异无统计学意义（P〉0．05）。但A组治愈率为88．10％，明显高于B组治愈率63．63％，差异有统计学意义（P〈0．05）。两组患者术前和术后3个月的肛门直肠压力无明显变化，差异无统计学意义（P〈0．05）；两组患者术前和术后3个月的内、外括约肌和耻骨直肠肌MUP平均时限比较，差异均无统计学意义（P〉0．05）。结论改良LIFT术较常规LIFT术明显提高治愈率，是治疗单纯性经括约肌型肛瘘的有效术式。

Objective To compare the efficacy of modified and routine ligation of intersphincteric fistula tract（LIFT） in the treatment of simple transsphincteric perianal fistula. Methods From January, 2013 to February, 2014, 86 patients with simple transsphincteric perianal fistula were randomized into group A （n=42） and group B （n=44）. Troup A were treated with modified LIFT operation and group B routine LIFT. The operation time, VAS score 24 h after the operation, wound healing time, hospital stay, and cured rate were compared between these 2 groups. Pelvic electromyogram （EMG） and anorectal manometry were used to evaluate the patients anal function three months after the operation. Results All cases have been followed up for 3-26 （8.73~7.15） months. There were no statistical differences in operation time, VAS score 24 h after the operation, wound healing time, and hospital stay between these 2 groups（P〉0.05）. The cured rate was 88.10% in group A and 63.60% in group B, with a statistical difference （P〈0.05）. There were no patients developed anal incontinence in both groups. There were no statistical differences in the duration of motor unit potential, occurrence of simple phase measured by pelvic EMG, and mean resting pressure and maximum squeeze pressure measured by anorectal manometry between before and 3 months after the operation in both groups（P〉0.05）. Conclusions Modified LIFT for simple transsphincteric perianal fistula is more effective and has a higher cured rate than routine LIFT.