联合术式治疗括约肌上型肛瘘

Combined surgical procedures in the treatment of suprashpincteric anal fistula

目的探讨部分瘘管切开、肛瘘栓填塞及改良推移皮瓣3种术式联合治疗括约肌上型肛瘘的疗效。方法将63例括约肌上型肛瘘患者分为研究组33例及对照组30例,对照组采用常规切开挂线术治疗,研究组采用部分瘘管切开、肛瘘栓填塞及改良推移皮瓣3种术式联合治疗,对比2组疗效。结果 2组均顺利完成手术,研究组手术时间长于对照组,术中出血量、需分次手术百分率、住院时间及视觉模拟评分法得分均少于对照组,比较差异均有统计学意义(P均<0.05)。研究组并发症发生率较对照组低(P<0.05)。2组伤口愈合率和复发率比较差异均无统计学意义(P均>0.05),研究组愈合时间较对照组短(P=0.001)。研究组术后Wexner肛门失禁评分、肛管最大收缩压均优于对照组(P均<0.05)。结论与常规切开挂线术比较,部分瘘管切开、肛瘘栓填塞及改良推移皮瓣3种术式联合治疗括约肌上型肛瘘的疗效更好,愈合时间更短,并发症发生率更低。

Objective To evaluate the clinical efficacy of partial fistulotomy,anal fistula plug repair combined with modified advanced flap in the treatment of suprashpincteric anal fistula. Methods Sixty-three patients with suprashpincteric anal fistula in our hospital were divided into the study （ n =33 ） and control groups （n = 30） . In the control group, patients received conventional fistulatomy and seton treatment,and those in the study group were treated with partial fistulotomy, anal fistula plug repair combined with modified advanced flap. Clinical efficacy between two groups was statistically compared. Results All patients success-fully completed the surgery. Compared with the control group, operation time was significantly longer, whereas intraoperative blood loss, multi-step surgery rate, length of hospital stay, visual analogue scale （VAS） score and incidence of postoperative complications were significantly less in the study group （all P 〈0. 05）. No sig-nificant differences were identified in the wound healing rate and recurrence rate between two groups （ both P〉0. 05 ）. The wound healing time in the study group was significantly shorter compared with that in the control group （P = 0. 001）. In the study group, Wexner incontinence score and anal canal maximum systolic pressure were significantly better than those in the control group （ both P 〈 0. 05 ）. Conclusions Compared with con-ventional fistulatomy and seton treatment, combined surgical procedures of partial fistulotomy, anal fistula plug repair and modified advanced flap yield higher clinical efficacy, shorter healing time and lower incidence of postoperative complications in the treatment of suprashpincteric anal fistula.