LIFT术与肛痰切除术治疗括约肌间型和经括约肌型肛痰的临床疗效观察

Clinical study on comparison ligation of intersphincteric fistula tract and fistulectomy treatment of the Inter-sphincteric anal fistula and Trans-sphincteric anal fistula

目的观察经括约肌间瘘管结扎术(LIFT)治疗括约肌间型肛瘘(ISAF)与经括约肌型肛瘘(TSAF)的临床疗效。方法回顾性分析上海市宝山区中西医结合医院肛肠科2015年3月至2015年12月所收治的75例ISAF及TSAF患者临床资料,按照手术方法的不同,分为治疗组及对照组。治疗组42例(其中ISAF32例、TSAF10例)采用LIFT术,对照组33例(其中ISAF27例、TSAF6例)采用肛瘘切除术。比较两组术后第1 d、3 d、7 d、14 d手术相关指标及术后并发症发生情况指标,并观察记录两组临床疗效指标。结果治疗组术后第1 d、3 d、7 d、14d创面疼痛、创面渗液情况均优于对照组,两组间差异均有统计学意义(均P<0.05);治疗组术后第7 d创面出血情况优于对照组,差异有统计学意义(P <0.05)。两组术后第1 d、3 d、7 d排尿不畅发生率差异均无统计学意义(均P> 0.05),两组术后第14 d均无排尿不畅病例;两组术后第1 d、3 d发热发生率差异均无统计学意义(均P> 0.05),两组术后第7 d、14 d均无发热病例;治疗组术后出现创面感染者3例,对照组无创面感染病例。治疗组创面愈合时间及术后住院时间均短于对照组(均P<0.05),组间住院费用差异无统计学意义(P> 0.05);治疗组治愈率为80.95%、复发率为19.05%,对照组治愈率为100%、无复发病例,组间差异有统计学意义(P<0.05)。两组术后均未出现创面红肿或溢脓现象,两组术后肛门失禁严重度指数评分均为0分。结论 LIFT治疗ISAF及TSAF的疗效良好,在促进术后创面愈合及减少住院费用方面具有一定的优势。

Objective To observe the efficacy of ligation of inter sphincteric stula tract treatment of the inter-sphincteric anal fistula and trans-sphincteric anal fistula. Methods The clinical data of 75 patients with ISAF and TSAF admitted to the Anorectal Department of Shanghai Baoshan Hospital from March 2015 to December 2015 were retrospectively analyzed. 42 cases in the treatment group （including 32 cases of ISAF and 10 cases of TSAF） were treated with LIFT, 33 cases in the control group （including 27 cases of ISAF and 6 cases of TSAF） were treated with anal fistulectomy. The operation related indices and postoperative complications were compared between the two groups on the 1^s6, 3^rd, 7^th and 14^th day after operation, and the clinical therapeutic indices were recorded. Results On the 1^st, 3^rd, 7^th and 14^th day after operation, the wound pain and wound seepage in the treatment group were better than those in the control group, and the difference between the two groups was statistically significant （P 〈 0.05）. On the 7^th day after operation, the wound bleeding in the treatment group was better than that in the control group, and the difference was statistically significant （P 〈 0.05）. For postoperative complications, there was no significant difference in the incidence of dysuria between the two groups on the 1^st, 3^rd and 7^th day （P 〉 0.05） and there was no dysuria in the the two groups on the 14^th day after operation, there was no significant difference in the incidence of fever between the two groups on the 1^stand 3^rd day after operation （P 〉 0.05） and there was no fever in the the two groups on the 7^th day and 14^th day after operation, there were 3 cases of wound infection after operation in the treatment group and no infection case in the control group. When it came to clinical efficacy indices, the wound healing time and postoperative hospitalization time of the treatment group were shorter than those of the control group （P 〈 0.05）, there was no significant difference in hospitalization costs between the two groups （P 〉 0.05）, the cure rate of the treatment group was 80.95% and the recurrence rate was 19.05%, the cure rate of the control group was 100% and there was no recurrence case, there was significant difference between the two groups （P 〈 0.05）. No redness or pyorrhea of wound was found in both groups and the FISI score was 0 in both groups. Conclusion LIFT was effective in the treatment of ISAF and TSAF, and had certain advantages in promoting wound healing and reducing hospitalization costs.