经括约肌间肛瘘结扎术治疗高位肛瘘的临床研究

Clinical study of ligation of intersphincteric fistula tract in the treatment of high anal fistula

目的研究经括约肌间肛瘘结扎术治疗高位肛瘘的临床效果。方法选取我院2013年10月~2015年5月的60例高位经括约肌肛瘘患者,按照随机数字表法分成治疗组和对照组,各30例。治疗组采用经括约肌间肛瘘结扎术,对照组采用传统切开挂线术。观察两组的住院时间、创面愈合时间,分别于术前1 d及术后第3个月评价患者的肛门功能情况。结果两组均顺利完成手术,两组的手术时间、治愈率、复发率、随访时间、大便失禁例数比较,差异无统计学意义(P>0.05)。治疗组的重返日常活动时间、住院天数和创面愈合时间短于对照组,差异有统计学意义(P<0.05)。两组术后3个月的Wexner分值、肛管最大收缩压、肛管静息压、直肠最小感觉容量、初始排便容量、最大耐受容量、最大收缩波幅优于治疗前,治疗组术后3个月的Wexner分值、肛管最大收缩压、肛管静息压、直肠最小感觉容量、初始排便容量、最大耐受容量、最大收缩波幅优于对照组,差异有统计学意义(P<0.05)。结论与传统切开挂线术相比,经括约肌间肛瘘结扎术的住院天数短,愈合时间短,能更快地重返日常活动,可以在保证治愈率前提下又能更好地保护肛门括约肌功能,具有重要的临床意义。

Objective To study the clinical efficacy of ligation of intersphincterie fistula tract in the treatment of high anal fistula.Methods From October 2013 to May 2015,60 patients with high sphincter anal fistula in our hospital were selected and divided into the treatment group （n=30） and the control group （n=30） according to random number table method.The treatment group was treated with ligation of intersphincteric fistula tract,and the control group was given the traditional incision and thread technique.The time of hospitalization and wound healing were observed in the two groups.The anus function was evaluated at 1 day before operation and 3 months after operation.Results The two groups completed the operation successfully,there were no significant differences in the operation time,cure rate,recurrence rate,follow-up time and the number of fecal incontinence between the two groups （P〉0.05）.The time to return to routine activities,hospitalization and wound healing time in the treatment group was shorter than that in the control group,with significant difference （P〈0.05）.The Wexner score,maximum systolic pressure of anal canal,anal canal rest pressure,rectal minimum sensory capacity,initial defecation capacity,maximum tolerance capacity and maximum systolic amplitude in the two groups at 3 months after treatment was better than that before treatment,the Wexner score,maximum systolic pressure of anal canal,anal canal rest pressure,rectal minimum sensory capacity,initial defecation capacity,maximum tolerance capacity and maximum systolic amplitude in the treatment group at 3 months after treatment was better than that in the control group,with significant difference （P〈0.05）.Conclusion Compared with the traditional incision and thread technique,ligation of intersphineteric fistula tract can shorten hospitalization and healing time,which can return to daily activities faster,can ensure the cure rate and better protect the anal sphincter function,so it has important clini- cal significance.