改良括约肌瘘管结扎术治疗单纯性经括约肌型肛瘘的临床疗效观察

Clinical efficacy of modified ligation of the fistula tract in treatment of simple transsphincteric analfistula

目的比较改良括约肌间瘘管结扎术(ligation of the intersphincteric fistula tract,LIFT术)和常规LIFT术治疗单纯性经括约肌型肛瘘的临床疗效。方法单纯性经括约肌型肛瘘病人92例,采用随机数字表法将92例病人随机分成两组,改良LIFT组46例,采用改良括约肌间瘘管结扎术,常规LIFT组46例,采用括约肌间瘘管结扎术。比较两组病人手术时间、术后疼痛评分、术后住院时间及愈合时间、治愈率,记录术前与术后3个月的肛门失禁Wexner评分,肛门直肠压力测定评估肛门功能变化。结果所有病人均获得随访3~26个月,平均(8.73±7.15)个月。两组病人的手术时间、术后疼痛评分和住院时间比较,差异无统计学意义(P>0.05)。改良LIFT组和常规LIFT组伤口愈合时间分别为(10.14±2.57)天和(23.87±4.68)天,差异有统计学意义(P<0.05),改良LIFT组治愈率为91.2%,常规LIFT组为71.7%,差异有统计学意义(P<0.05);两组均无肛门失禁发生,两组术前及术后3个月Wexner失禁评分及肛门直肠压力变化比较,差异无统计学意义(P>0.05)。结论改良LIFT术在保护肛门功能的同时能够提高治愈率,缩短术后住院时间及愈合时间,在单纯性经括约肌型肛瘘的手术中可推广应用。

Objective To evaluate the clinical effects of modified ligation of the fistula tract（ LIFT） in the treatment of simple transsphincteric anal fistula. Methods 92 patients with a clinical diagnosis of simple transsphincteric anal fistula were enrolled into the research. According to the random number table patients divided into the modified group（ 46 cases） and the normal group（ 46 cases） randomly.Operation time,postoperative pain score,postoperative hospitalization time,healing time and healing rate in two groups were compared,Wexner anal incontinence scores and anorectal manometry 3 months after operation were analyzed to evaluated anal function. Results All patients were followed up for 3 -26 months,average（ 8. 73 ± 7. 15） months. Comparing with operation time,hospitalization time,postoperative pain score 24 h after operation,hospital stay had no significantly different between the two groups（ all P〉 0. 05）. The healing time had significantly different between the modified group [（ 10. 14 ± 2. 57） d] with the normal group [（ 23. 87 ± 4. 68） d]（ P〈0. 05）; The healing rate in modified group was（ 91. 2 %） significantly higher thanin normal group（ 71. 7 %）（ P〈0. 05）. By the Wexner anal incontinence scores and anorectal manometry 3 months after operation were not significantly different（ P〉0. 05）. Conclusion Modified LIFT is a safe technique with a high healing rate and a shorter healing time,in the treatment of simple transsphincteric anal fistula,modified LIFT procedures should be considered.