肛门内外括约肌部分联合切断术治疗陈旧性肛裂的临床研究

Clinical Study on Amputation of Internal and External Sphincter in the Treatment of Old Anal Fissure

目的观察和评价肛门后侧内括约肌联合部分外括约肌切断术治疗陈旧性肛裂的临床疗效。方法将2012年8月-2014年6月收治的80例陈旧性肛裂患者随机分为试验组和对照组,每组40例,试验组采用肛门后侧内括约肌联合部分外括约肌切断术,对照组采用单纯肛门内括约肌侧切术。观察两组的治愈情况、愈合时间、术后排便疼痛程度、术后肛门控便控气及肛裂复发率。结果试验组40例均痊愈,治愈率100%;创口愈合时间(17.0±3.5)d。对照组38例痊愈,2例未愈,治愈率95%;创口愈合时间(10.5±3.8)d。两组疗效比较差异无统计学意义(P>0.05);试验组创口愈合时间较对照组长,差异有统计学意义(P<0.05)。试验组术后首次及3、7、15 d排便肛门疼痛程度均较对照组轻,差异有统计学意义(P<0.05)。术后随访6个月,仅试验组1例患者于术后3个月发生稀便失控,其余患者均未发生术后肛门稀便和(或)气体失控及肛裂复发情况,两组比较差异均无统计学意义(P>0.05)。结论肛门后侧内括约肌联合部分外括约肌切断术治疗陈旧性肛裂,疗效确切,能明显减轻术后排便疼痛,利于术后排便,是治疗陈旧性肛裂的较为理想的术式。

Objective To observe and assess the therapeutic effect of posterior amputation of internal sphincter and partial external sphincter in the treatment of old anal fissure. Methods Eighty patients with old anal fissure treated between August 2012 and June 2014 were randomly divided into study group and control group with 40 in each. The study group received posterior amputation of internal sphincter and partial external sphincter, while the control group underwent single amputation of internal sphincter. Then we observed the cure rate, wound healing days, pain at defecation after operation, defecation control after operation, and long-term recurrence rate. Results All the 40 patients in study group were healed with a recovery rate of 100%, while 38 in control group were healed with a recovery rate of 95%; the difference between the two groups were not significant （P 〉 0.05）. The wound healing time in study group [（17.0±3.5） days] was much longer than that in the control group [（10.5±3.8） days] （P 〈 0.05）. The pain extents of fundament during defecating on the first day and 3, 7, and 15 days later in study group were more alleviated than those in the control group （P 〈 0.05）. In the six-month follow-up period, one patient in study group had liquid stools out of control 3 months after the surgery, and the others had no similar symptoms （P 〉 0.05）. Conclusions Posterior amputation of internal sphincter and partial external sphincter is a reasonable method for the treatment of old anal fissure. It can not only cure old anal fissure but also alleviate pain at defecation after operation and facilitate defecation.