探讨改良切开扩创手术治疗Ⅱ、Ⅲ期陈旧性肛裂的临床应用价值

Study on Clinical Application Value of Modified Incision and Expansion Operation in Treatment of Old Anal Fissure in the Stage Ⅱ and Stage Ⅲ

目的探讨改良切开扩创手术治疗Ⅱ、Ⅲ期陈旧性肛裂的临床应用价值。方法选取该院(2015年1月—2017年1月)收治的陈旧性肛裂患者70例为该研究对象,将所有符合标准的患者根据治疗方法差异分为2组,观察组35例患者给予改良切口扩创术治疗,对照组35例患者给予后位内括约肌离术治疗,对比两组患者临床疗效、术后并发症发生率、肛门功能、疼痛程度。结果两组患者临床治疗总有效率(100.00%vs 97.14%),差异无统计学意义(χ~2=2.901 5,P>0.05);但观察组痊愈率71.43%明显高于对照组45.71%,差异有统计学意义(χ~2=13.630 8,P<0.05);观察组患者术后并发症发生率22.86%明显低于对照组57.14%,差异有统计学意义(χ~2=24.481 6,P<0.05);观察组患者Willianms评分Ⅰ级85.71%明显高于对照组71.43%,差异有统计学意义(χ~2=6.055 5,P<0.05);观察组患者VAS评分(2.84±0.24)分明显低于对照组(3.19±0.30)分,差异有统计学意义(t=5.389 6,P<0.05)。结论改良切开扩创手术治疗Ⅱ、Ⅲ期陈旧性肛裂疗效显著,能更好的恢复肛门功能,降低疼痛,且安全性高,值得临床推广。

Objective To study the clinical application value of modified incision and expansion operation in treatment of old anal fissure in the stageⅡand stageⅢ.Methods 70 cases of patients with old anal fissure admitted and treated in our hospital from January 2015 to January 2017 were selected and divided into two groups according to different treatment methods with 35 cases in each,the observation group and the control group were respectively treated with modified incision and expansion operation and posterior internal sphincter cutting surgery,and the clinical curative effect,incidence rate of postoperative complications,anal function and pains degree were compared between the two groups.Results The difference in the total clinical treatment effective rate between the two groups was not obvious,without statistical significance(100.00%vs 97.14%)(χ2=2.901 5,P>0.05);and the healing rate in the observation group was obviously higher than that in the control group,and the difference was not statistically significant,(71.43%vs 45.71%)(χ2=13.6308,P<0.05),and the incidence rate of complications after surgery in the observation group was obviously lower than that in the control group(22.86%vs 57.14%),and the difference was statistically significant,(χ2=24.481 6,P<0.05),and the Willianms score levelⅠin the observation group was obviously lower than that in the control group,[(2.84±0.24)points vs(3.19±0.30)points],and the difference was statistically significant(t=5.389 6,P<0.05).Conclusion The curative effect of modified incision and expansion operation in treatment of old anal fissure in the stageⅡand stageⅢcan better recover the anal function,and reduce pains with high safety,which is worth promotion.