肛瘘切开术与切除术治疗低位单纯性肛瘘中的价值

The Value of Anal Fistulotomy and Resection in the Treatment of Low Simple Anal Fistula

目的分析比较肛瘘切开术与切除术治疗低位单纯性肛瘘的价值。方法方便选择2014年7月—2016年7月该院所收治的120例明确诊断为低位单纯性肛瘘患者进行研究。按照随机数字表法分为肛瘘切开组(n=60)和肛瘘切除术组(n=60),两组采用相同的术前准备、麻醉方式和术后管理。对比两组手术操作时间和术中出血量,研究分析两组术后切口愈合时间、切口并发症(疼痛、出血及感染)、复发率、早期排便次数、大便失禁和狭窄并发症发生率。结果肛瘘切开术组手术操作时间为(16.1±2.3)min,肛瘘切除术组手术操作时间为(13.8±3.2)min,两组数据差异有统计学意义(t=4.520 8,P=0.013 1);肛瘘切开术组手术切开愈合时间为(22.5±4.5)d,肛瘘切除术组手术愈合时间为(28.8±4.6)d,两组数据差异有统计学意义(t=8.91,P=0.010 1);肛瘘切开术组早期排便次数为(1.5±0.5)次,肛瘘切除术组早期排便次数为(2.5±1.5)次,两组数据差异有统计学意义(t=3.167,P=0.002)。而两组在术中出血量、术后因切口疼痛导致的镇痛药使用率、切开疼痛评分方面差异无统计学意义(P>0.05)。术后随访1年,肛瘘切开术组患者术后复发率高于肛瘘切除术组,差异有统计学意义(P<0.05)。两组大便失禁和狭窄并发症发生率均差异无统计学意义(P>0.05)。结论肛瘘切除术与切除术在治疗低位单纯性肛瘘方面,操作简单,伤口较小,手术操作时间短、恢复快,但远期复发率高于肛瘘切除术。

Objective To analyze and compare the value of anal fistula incision and resection in the treatment of simple anal fistula.Methods A total of 120 patients diagnosed with low-level simple anal fistula admitted to the hospital from July 2014 to July 2016 were convenient selected for study.In accordance with the random number table method was divided into anal fistula incision group(n=60)and anal fistula resection group(n=60),the two groups used the same preoperative preparation,anesthesia and postoperative management.The operation time and intraoperative blood loss were compared between the two groups.The incision healing time,incision complications(pain,bleeding,and infection),recurrence rate,number of early defecation,fecal incontinence and stenosis complications were analyzed.Results The operation time of the anal fistulectomy group was(16.1±2.3)min,and the operation time of the anal fistula resection group was(13.8±3.2)min.Between the two groups the difference was statistically significant(t=4.520 8,P=0.013 1);anal fistula was opened,the surgical incision healing time was(22.5±4.5)days in the surgical group and(28.8±4.6)days in the anal fistula resection group.The difference between the two groups was statistically significant(t=8.91,P=0.010 1);the anal fistula group early frequency of defecation was(1.5±0.5)times,and the number of defecation in the first stage of anal fistula was(2.5±1.5)times.The difference between the two groups was statistically significant(t=3.167,P=0.002).There was no significant difference between the two groups in intraoperative blood loss,postoperative analgesic use rate and incision pain score(P>0.05).After 1 year of follow-up,the recurrence rate of the anal fistulectomy group was higher than that of the anal fistula resection group,and the difference was statistically significant(P<0.05).The incidence of fecal incontinence and stenosis was not statistically significant between the two groups(P>0.05).Conclusion Anal fistula resection and resection in the treatment of low-level simple anal fistula,the operation is simple,the wound is small,the operation time is short,rapid recovery,but the long-term recurrence rate is higher than the anal fistula resection.