结扎术配合补片与切开挂线术治疗肛瘘的疗效比较

Comparative study on the effect of ligation combined with mesh and incision-thread-drawing procedure in the treatment of anal fistula

目的比较结扎术配合补片与肛瘘切开挂线术治疗肛瘘的临床疗效。方法选择2014年1月至2016年8月期间深圳市南山区人民医院肛肠科收治的280例肛瘘患者为研究对象,根据随机数表法分为对照组和观察组,每组140例,对照组予切开挂线术治疗,观察组予结扎术配合补片治疗,比较两组患者的手术时间、住院时间及创面愈合时间。术后3 d采用视觉模拟疼痛评估(VAS)法评价疼痛程度,出院时应用Wexner肛门失禁评分评价肛门功能,随访1年时记录复发率。结果两组患者的手术时间比较差异无统计学意义(P>0.05);观察组患者术后VAS评分及Wexner评分分别为(0.8±0.4)分、(1.1±0.4)分,明显低于对照组的(1.3±0.6)分、(1.4±0.5)分,住院时间及创面愈合时间分别为(9.8±3.6)d、(13.2±4.7)d,明显短于对照组的(13.5±4.9)d、(19.8±6.2)d,差异均有统计学意义(P<0.05);术后随访1年,观察组患者的复发率为1.43%,明显低于对照组的5.00%,差异有统计学意义(P<0.05)。结论结扎术配合补片治疗肛瘘具有创伤小、术后疼痛轻、术后恢复快及对肛门功能影响小、复发率低的优势。

Objective To compare the clinical effect of ligation combined with mesh and incision-thread-drawing procedure in the treatment of anal fistula. Methods From January 2014 to August 2016, 280 patients with anal fistula in Department of Anus Intestine Surgery of Shenzhen Nanshan District People＇s Hospital, according to random number table method, were assigned into two groups, with 140 patients in each group. The control group received incision-thread-drawing procedure, and the observation group was given ligation with mesh treatment. The operation time,hospitalization time and the healing time of the wound were compared. The pain degree at 3 day was evaluated after operation（VAS）. Anal function was evaluated by Wexner anal incontinence score at discharge, and the recurrence rate was recorded after 1 year of follow-up. Results There was no significant difference between the two groups in operation time（P0.05）. The VAS score and Wexner score in the observation group were（0.8±0.4）,（1.1±0.4）, significantly lower than（1.3±0.6）,（1.4±0.5） in the control group（P0.05）, and hospitalization time and the healing time was（9.8±3.6） d,（13.2±4.7） d, significantly shorter than（13.5±4.9） d,（19.8±6.2） d in the control group（P0.05）. During the follow-up,the recurrence rate of the observation group（1.43%） was significantly lower than that in the control group（5.00%）, P0.05. Conclusion Ligation combined with mesh for anal fistula has advantages of less trauma, less postoperative pain,quicker postoperative recovery, less influence on anal function, and low recurrence.