括约肌间瘘管结扎术与切开挂线术治疗复杂性肛瘘的临床对比研究

Clinical comparison of ligation of the intersphincteric fistula tract and incision and thread drawing for complicated anal fistula

目的 探讨括约肌间瘘管结扎术与切开挂线术在复杂性肛瘘治疗中的应用效果.方法 选取2014年6月至2017年9月于本院治疗复杂性肛瘘患者100例,随机将其分为两组,各50例.对照组行切开挂线术治疗,观察组行括约肌间瘘管结扎术治疗.对比两组临床疗效、手术指标、肛门功能及并发症发生情况.结果 观察组治疗总有效率（94.00％）较对照组（78.00％）高,差异有统计学意义（P＜0.05）;观察组手术时间较对照组长[（45.43±7.82）min比（39.04±6.33）min],术中失血量[（28.27±4.73）ml比（41.51±5.62） ml]、创面愈合时间[（25.41±4.03）d比（38.22±3.70）d]、住院时间[（8.04±1.22）d比（12.20±3.07）d]短于对照组,差异有统计学意义（P＜0.05）;术后1周,观察组Wexner评分高于对照组[（5.42±0.86）分比（3.84±0.73）分],差异有统计学意义（P＜0.05）;观察组并发症（16.00％）少于对照组（36.00％）,差异有统计学意义（P＜0.05）.结论 括约肌间瘘管结扎术治疗复杂性肛瘘较切开挂线术可提升该病治疗效果,具有失血少、术后易恢复等优势,且可改善患者肛门功能,减少并发症发生.

Objective To explore the effect of ligation of the intersphincteric fistula tract and incision and thread drawing in the treatment of complicated anal fistula.Methods 100 patients with complicated anal fistula in our hospital from June 2014 to September 2017 were randomly divided into two groups,50 cases in each group.The control group was treated by incision and thread drawing therapy,while the observation group was treated by ligation of the intersphincteric fistula tract.The clinical efficacy,operative index,anal function,and complications were compared between the two groups.Results The total effective rate of treatment in the observation group （94%） was higher than that in the control group （78%）,with statistically significant difference （P〈0.05）;the operation time of the observation group was higher than that of the control group [（45.43±7.82） min vs.（39.04±6.33） min],the blood loss,wound healing time,and hospitalization time of the observation group were less than those of the control group [（28.27±4.73）ml vs.（41.51±5.62）ml,（25.41±4.03）d vs.（38.22±3.70） d,（8.04±1.22）d vs.（12.20±3.07）d],with statistically significant differences （P〈0.05）.1 week after operation,the score of Wexner in the observation group was higher than that in the control group [（5.42±0.86） vs.（3.84±0.73）]（P〈0.05）,and the incidence of complications in the observation group （16%） was less than that in the control group （36%）,with statistically significant difference （P〈0.05）.Conclusion Ligation of the intersphincteric fistula tract in the treatment of complicated anal fistula can improve the therapeutic effect of the disease compared with incision and thread drawing,has the advantages of less bleeding and easy recovery after operation,can improve the function of the anus and reduce the complications.