潜行刨削术治疗复杂性肛瘘的临床效果观察

Effect of cannulation and scraping in treating complex fistula

目的探讨潜行刨削术治疗复杂性肛瘘的临床效果。方法选择本院2015年5月至2017年4月收治的110例复杂性肛瘘患者为研究对象,采用随机数字表法分为观察组和对照组,每组各55例。观察组采用潜行刨削术治疗,对照组采用切开挂线术治疗。比较两组患者术后疼痛程度、住院时间、创面愈合时间、肛门功能指数评分、肛门失禁功能评分、肛肠动力学指标情况。结果术后第1 d、 7 d,观察组VAS评分均低于对照组,差异均有统计学意义(均P <0.05)。观察组住院时间、创面愈合时间均短于对照组,差异均有统计学意义(均P <0.05)。术前两组肛门功能指数评分、Wexner肛门功能评分比较差异均无统计学意义(均P> 0.05);术后观察组上述指标均低于对照组,差异均有统计学意义(均P <0.05)。两组术前肛管最大收缩压、肛管静息压、直肠静息压比较均差异无统计学意义(均P> 0.05);术后观察组上述指标均高于对照组,差异均有统计学意义(均P <0.05)。术后随访观察12个月,观察组有4例(7.27%)患者复发,对照组有9例(16.36%)患者复发,两组复发率比较差异无统计学意义(P> 0.05)。结论潜行刨削术治疗复杂性肛瘘具有创面愈合快及对患者肛门括约肌功能、肛门直肠功能影响小的优势,具有一定的临床推广应用价值。

Objectives To investigate the effect of cannulation and scraping in treating complex fistula. Methods 110 patients treated in our hospital between May 2015 and April 2017 were selected and randomly assigned to treatment group and control group, with 55 patients in each group. Patients in treatment group received cannulation and scraping and patients in control group received incision and seton. We compared between the two groups postoperative pain, duration of hospitalization, time to wound healing, anal function score, incontinence score and anal dynamics indices. Results VAS pain score at 1 and 7 days after surgery was significantly lower in the treatment group than in the control group (P < 0.05). Duration of hospitalization and time to wound healing were significantly shorter in the treatment group (P < 0.05). There was no significant difference between the two groups in anal function score and Wexner function before surgery (both P > 0.05). These scores after surgery were significantly lower in treatment group than in control group (P < 0.05). There were no significant difference in maximum anal systolic pressure, anal resting pressure and rectal resting pressure between the two groups before surgery (P > 0.05). These indices after surgery were significantly higher in treatment group than in control group (P < 0.05). Patients were followed-up for 12 months. Four (7.27%) and nine (16.36%) patients in treatment group and control group, respectively, had recurrence. There was no significant difference in recurrence rate between the two groups (P > 0.05). Conclusion Cannulation and scraping could promote wound healing and has fewer impact on patients sphincter function, as well as anal and rectal function. It had potential in clinical use.