低切高挂半缝合半开放引流术治疗高位肛瘘

FISTULECTOMY,PARTIAL SUTURING AND SEMI-OPEN DRAINAGE IN LOW FISTULA AND THREAD-DRAWING IN HIGH FISTULA FOR THE TREATMENT OF HIGH ANAL FISTULA

目的 :探讨治疗高位肛瘘的手术方式。方法 :5 0例高位肛瘘分为 2组 ,试验组直肠环以上瘘管挂线 ;直肠环以下瘘管切除 ,肛门外切口间断全层缝合 ,肛门内切口开放引流。对照组直肠环以上瘘管挂线 ;直肠环以下瘘管切开。结果 :(1)治愈率 :试验组 10 0 % (2 5 / 2 5 ) ,对照组 96 % (2 4 / 2 5 )。 (2 )伤口愈合时间 :试验组 (9.0 4± 1.93) d,对照组 (2 4 .6± 4 .2 2 )d (P <0 .0 1)。 (3)肛管弹性 :试验组术前优 18例、良 6例、差 1例 ;术后优 16例、良 7例、差 2例。对照组术前优 2 0例、良 3例、差 2例 ;术后优 11例、良 9例、差 5例。 (4)肛门平滑度 :试验组术后正常 2 4例 ,对照组术后正常 3例。(5 )伤口水肿 :试验组 2 3例 (92 % ) ,对照组无。 (6 )伤口疼痛 :试验组重度 2 1例、中度 3例、轻度 1例。对照组重度 2例、中度 2 0例、轻度 3例。 (7)伤口感染 :试验组 2例、对照组 1例。结论 :瘘管切除半缝合半开放引流术在保持肛门的功能。

Objective: To investigate the operative pattern in treatment of high anal fistula Methods:50 cases with high anal fistula were divided into two groups The tract under rectal annulus was resected and the tract above rectal annulus was treated by thread drawing and the wound skin out of auns was sutured by discontinuity in 25 cases (Rs group) The tract under rectal annulus was incised and the tract above rectal annulus was treated by thread drawing in othe 25 cases (control group) Results:(1)The cure rates were 100% in Rs group and 96% in controls (2)Healing time of the operative wound was(9 04±1 93)days in Rs and (24 16±4 22)days in controls, P<0 01 Elasticity of anal canal: excellent in 18(post op) and 16 cases (pre op), good in 6(pre op) and 7 cases (post op), poor in 1(pre op) and 2 cases (post op) in Rs group in contrast with excellent in 20(pre op) and 11 cases (post op), good in 3(pre op) and 9 cases (post op), poor in 2(pre op) and 5 cases (post op) in control group Nomal level of anal canal were 24 cases in Rs group and 3 cases in control group The edema of incision developed in 23 cases in Rs and none in controls Postoperative anal pain:mild in 1, moderate in 3 and severe in 21 cases in Rs campared with mild in 3, moderate 20 and secere in 2 cases in controls Infection of wound were 2 cases in Rs and 1 case in controls Conclusion: In the aspects of anal function, short treatment course and restoration of the normal contour of anus, fistulectomy with partial suturing and Semi open drainage is superior to fistulatomy with open drainage