激光消融闭合术治疗肛瘘的临床疗效观察

Effect of fistula-tract laser closure treatment for fistula-in-ano

目的观察激光消融闭合术(FiLaC)治疗肛瘘的临床疗效。方法回顾性分析25例接受激光消融闭合术治疗的Parks分类I、II型肛瘘患者临床资料,观察记录治疗效果、手术后并发症及复发情况、术后疼痛程度及术后肛门失禁情况。结果共25例患者接受了肛瘘激光消融闭合术,中位随访时间为11(4~20)个月。其中,19例(76%)术后愈合;15例患者术后出现伤口疼痛,10例患者术后出现伤口渗液,5例患者术后出现伤口渗血,4例患者术后出现肛门坠胀,无患者出现伤口感染和术后尿潴留;内口处理分别采用激光闭合、缝合、切除三种方式,术后有6例瘘管未闭合,2例复发;VAS评分结果显示有10例患者术后VAS评分为0,术后当天中位VAS评分为2(0,6)分,术后第1天为2(0,4)分,术后第3天为1(0,2)分,术后第5天为0(0,1)分;无一例患者出现术后肛门失禁。结论FiLaC治疗肛瘘能完整保留括约肌,术后疼痛较轻,患者体验好,是一项安全、有效、操作简便的术式。

Objectives To investigate the effect of fistula-tract laser closure (FiLaC) treatment for fistula-in-ano management. Methods This was a retrospective analysis of 25 patients with type I and II fistula-in-ano according to the Parks classification system who received fistula-tract laser closure treatment, Treatment effect, postoperative complications and recurrence, postopera tive pain and postoperative anal incontinence were observed and recorded. Results Twenty-five patients received fistula-tract la ser closure treatment. The median follow-up was 11 (4-20) months. Nineteen (76%) patients healed after operation, 15 patients had wound pain. 10 patients had oozing from the wound, and 5 patients had blood flowing from the wound, 4 patients had anal straining. No patient had wound infection or postoperative urinary retention. Internal openings were treated by laser, suture or ex cision. There were 6 failed closures and 2 recurrences. 10 patients had visual analog scale (VAS) score of 0 after surgery. The median VAS score on the day of surgery was 2 (0, 6), 2 (0, 4) on the first day, 1 (0, 2) on the third day, and 0 (0,1) on the fifth day after surgery. No patient reported postoperative incontinence. Conclusion The FiLaC procedure for fistula can preserve the sphincter, with mild postoperative pain and excellent satisfaction. It is a safe, effective and simple operation.