定向挂线法治疗高位复杂性肛瘘效果分析

Directional Thread-drawing Procedure for High Complex Anal Fistula：An Analysis of Efficacy

为了观察定向挂线法治疗高位复杂性肛瘘的临床疗效，将2013年6月至2016年6月，山东省巨野县人民医院肛肠外科收治的高位复杂性肛瘘患者86例，按随机数字表法分为对照组和观察组，每组各43例。对照组采用传统切开挂线疗法，观察组采用定向挂线法。采用主观疼痛模拟评分表（VAS法）对患者疼痛感进行量化评分。通过比较2组患者术后2d疼痛情况、术后3个月肛门功能恢复情况的差异，以及术后6个月病情复发情况，综合评价手术治疗方案疗效差异。结果显示，观察组患者术后2d的VAs评分为（4．7±2．7）分，低于对照组（8．3±5．1）分，差异有显著统计学意义（P〈0．001）。观察组患者术前检测肛管静息压（ARP）、肛管最大收缩压（AMCP）较对照组差异无统计学意义（P〉0．05）。术后观察组患者ARP、AMCP低至（3．4±2．1）kPa、（6．1±4．6）kPa低，较对照组（6．1±3．7）kPa、（10．9±6．7）kPa低，差异有统计学意义（P〈0．05）。术后6个月，观察组2例复发，占4．7％（2／43），低于对照组复发的5例（P〈0．001）。结果表明，定向挂线法治疗高位复杂性肛瘘，对患者肛门括约肌损伤小，有效减轻患处疼痛，较传统切开挂线疗法疗效显著，值得临床推广应用。

This study was to observe the clinical effect of directional thread-drawing procedure for high complex anal fistula,randomly divided 86 patients with this fistula who admitted in author＇s hospital from June 2013 to June 2016 yr. into control group and observation one,43 cases for each;gave the former rou- tine incision and thread-drawing procedure, meanwhile the latter accepted above directional thread-drawing procedure;then,took quantification score for patient＇s pain by using VAS method;through observing and comparing pain status 2 days after operation,difference in anal function recovery status 3 months after op eration,and recurrence status 6 months after operation evaluated effect difference between both surgical schemes comprehensively.As results,2 days after operation in VAS rating there was significant difference between both groups（4.7± 2.7 vs 8.3 ± 5.1, P 〈 0.001 ）, peroperative detection of ARP and AMCP there was no statistical difference（ P 〈0.05）,but after operation in the latter ARP and AMCP decreased up to （3.4 ± 2.1 ） kPa, and （6.1± 4.6） kPa having statistical difference compared with the former [（6.1 ± 3.7 ） kPa,and （10.9±6.7） kPa, P 〈0.05],6 months after operation in the latter recurrence rate higher than in the latter（2/43,4.7 % vs 5/43,11.6 %, P 〈0.001）.Results show that directional thread-drawing procedure for high complex anal fistula has such merits as less injury to anal sphincter,effectively reducing patient＇s pain,and better effect than routine incision thread-drawing procedure.