肛门后正中切扩加肛窦切开引流术与内括约肌侧切术治疗慢性肛裂疗效比较

Clinical observation of posterior anus median incision combined with anal sinus incision drainage and lateral internal sphincterotomy in the treatment of chronic anal fissure

目的比较肛门后正中切扩加肛窦切开引流术与内括约肌侧切术治疗慢性肛裂的临床疗效。方法选择东莞市凤岗人民医院外二科于2013年5月至2017年6月期间收治的94例慢性肛裂患者为研究对象,根据随机数表法分为观察组和对照组,每组47例。观察组予肛门后正中切扩加肛窦切开引流术治疗,对照组予内括约肌侧切术治疗,比较两组患者术后疼痛情况、愈合时间、切口感染发生率,出院时比较两组患者的临床疗效;术后随访半年,比较两组复发情况。结果治疗后,观察组患者的治疗总有效率为100.00%,与对照组的97.87%比较,差异无统计学意义(P>0.05);观察组患者术后VAS评分为(4.2±1.4)分,明显高于对照组的(3.5±1.3)分,愈合时间为(16.9±4.3)d,明显长于对照组的(12.1±3.2)d,差异均有统计学意义(P<0.05);观察组患者术后切口感染率为4.26%,随访期间复发率为6.38%,均明显低于对照组的14.89%和19.15%,差异均有统计学意义(P<0.05)。结论肛门后正中切扩加肛窦切开引流术与内括约肌侧切术均是治疗慢性肛裂的有效术式,肛门后正中切扩加肛窦切开引流术的创伤相对较大,愈合时间较长,但是术后感染发生率及复发率均较低。

Objective To compare the clinical effect of posterior anus median incision combined with anal sinus incision drainage and lateral internal sphincterotomy（LIS） in the treatment of chronic anal fissure.Methods Ninety-four chronic anal fissure patients who were treated in Second Surgical Department in Dongguan Fenggang People＇s Hospital from May 2013 to June 2017 were selected as the research objects.According to the random number table they were divided into observation group and control group,with 47 patients in each group.The observation group received posterior anus median incision combined with anal sinus incision drainage,and the control group were treated with lateral internal sphincterotomy.The postoperative pain,healing time and incision infection rate were compared between the two groups.The clinical efficacy of the two groups was compared at discharge time.The recurrence rate of the two groups were compared after six months of follow-up.Results After treatment,the total effective rate of observation group was 100.00% versus 97.87% in the control group,with no statistically significant difference（P〈0.05）.The VAS score in the observation group was（4.2±1.4）,which was significantly higher than（3.5±1.3） in the control group（P〈0.05）.The healing time in the observation group was（16.9±4.3） d,which was significantly longer than（12.1±3.2） d in the control group（P〈0.05）.The postoperative incision infection rate in observation group（4.26%） and the recurrence rate（6.38%） during the follow-up period were significantly lower than 14.89% and 19.15% in the control group（P〈0.05）.Conclusion Posterior anus median incision combined with anal sinus incision drainage and LIS are effective methods for the treatment of chronic anal fissure,but posterior anus median incision combined with anal sinus incision drainage results in large wound longer healing time,and lower incidence and recurrence rate of postoperative infection.