中药药线对口引流法与高位挂线低位全部切开术治疗高位复杂性肛瘘临床比较

Clinical Comparison of Traditional Chinese Medicine Medicated Thread-drawing Drainage and High Thread-drawing with Low Incision for High Complex Anal Fistula

目的：比较中药药线对口引流法与高位挂线低位全部切开术治疗高位复杂性肛瘘的临床疗效。方法：选取我院2010年2月—2015年2月96例高位复杂性肛瘘患者为研究对象,将纳入患者按随机数表法分为中医组与对照组,每组48例。中医组采用中药药线对口引流法,对照组采用高位挂线低位全部切开术,比较两组术中及术后指标、肛管直肠压力、肛门功能评分、肛门形态评分、肛门失禁评分、疼痛评分、临床疗效、术后并发症及复发率。结果：中医组伤口愈合时间、术后1个月肛门功能评分、肛门形态评分、肛门失禁评分、术后7 d疼痛评分分别为（32.24±9.15）d、（1.03±0.45）分、（1.71±0.67）分、（4.64±1.19）分、（1.35±0.65）分显著低于对照组的（38.19±10.36）d、（1.45±0.69）分、（2.18±0.72）分、（5.27±1.33）分、（1.69±0.93）分（P〈0.05）,术后1个月肛管静息压、肛管舒张压、肛管最大收缩压分别为（7.22±1.59）、（3.94±0.53）、（18.05±2.19）k Pa显著高于对照组的（6.41±1.24）、（3.63±0.58）、（16.68±1.84）k Pa（P〈0.05）。结论：中药药线对口引流法治疗高位复杂性肛瘘,可以促进创面愈合,减轻术后疼痛,维护肛门形态,保护肛门功能,较高位挂线低位全部切开术具有一定优势。

Objective：To compare the clinical efficacy of traditional Chinese medicine（TCM）medicated thread-drawing drainage and high thread-drawing with low incision for high complex anal fistula. Methods：A total of 96 patients with high complex anal fistula treated in the hospital from February 2010 to February 2015 were selected as study subjects,and they were randomly divided into the TCM group and the control group with 48 patients in each group by the random number table method. The TCM group were treated with TCM medicated thread-drawing drainage while the control group were treated with high threaddrawing and low incision. The intraoperative and postoperative indexes,anorectal pressure,anal function score,anal shape score,anal incontinence score,pain score,clinical efficacy,postoperative complications and recurrence rate were compared between the two groups. Results：The wound healing time,anal function score,anal shape score and anal incontinence score in the TCM group at 1 month after operation,and pain score at 7 d after operation were significantly shorter or lower than those in the control group[（32.24±9.15） d,（1.03±0.45）points,（1.71±0.67）points,（4.64±1.19）points and（1.35±0.65）points vs（38.19±10.36）d,（1.45±0.69）points,（2.18±0.72）points（5.27±1.33）points and（1.69±0.93）points]（P〈0.05）. 1 month after operation,the anal resting pressure,anal diastolic pressure and the maximal anal systolic pressure of the TCM group were significantly higher than those of the control group [（7.22±1.59）k Pa,（3.94±0.53）k Pa and（18.05±2.19）k Pa vs（6.41±1.24）k Pa,（3.63±0.58）k Pa and（16.68±1.84）k Pa]（P〈0.05）. Conclusion：TCM medicated thread-drawing drainage can promote wound healing,reduce postoperative pain,maintain the anal shape,and protect the anal function in patients with high complex anal fistula. It has certain advantages over high thread-drawing and low incision.