括约肌间瘘管结扎术治疗高位复杂性肛瘘的疗效分析

Clinical Efficacy Evaluation of Ligation of the Intersphincteric Fistula Tract in Treating High Complex Anal Fistula

目的对比观察括约肌间瘘管结扎术治疗高位复杂性肛瘘的临床疗效。方法选取2016年5月至2018年4月娄底市中心医院肛肠外科收治的66例高位复杂性肛瘘患者作为研究对象,并按照随机数表法将其随机分为观察组(33例)与对照组(33例),其中观察组患者采用括约肌间瘘管结扎术治疗,对照组患者采用切开挂线术治疗,对比观察两组患者的手术时间、术中出血量、术后创面面积、创面愈合时间、住院时间、肛门控便功能、并发症发生率及1年内的复发率。结果观察组患者手术时间显著长于对照组(t=2.483,P=0.016)、术中出血量显著少于对照组(t=8.190,P=0.000)、术后创面面积显著小于对照组(t=24.696,P=0.000)、创面愈合时间与住院时间显著短于对照组(t=3.280、2.369,P=0.002、0.021)。术后1周、1个月、3个月与6个月观察组患者Wexner评分均明显低于对照组(t=5.292、3.248、6.330、7.031,P=0.000、0.002、0.000、0.000),术后并发症发生率及复发率亦均显著低于对照组(χ^2=4.694、5.121,P=0.030、0.024)。结论与切开挂线术相比,括约肌间瘘管结扎术治疗高位复杂性肛瘘可有效减少术中出血量,缩短术后创面愈合时间,保护肛门括约肌功能,降低并发症发生率及复发率,值得临床推广应用。

Objective To comparatively observe the clinical efficacy of the ligation of the intersphincteric fistula tract(LIFT)in the treatment of high complex anal fistula.Methods Sixty-six patients with high complex anal fistula admitted into the Anorectal Surgery Department of Loudi Central Hospital between May 2016 and April 2018 were selected as subjects to be divided into an observation group(33 patients)and a control group(33 patients)according to the random number table.In the observation group,the patients were treated with the ligation of the intersphincteric fistula tract while the patients in the control group were treated with the incision-thread-drawing procedure.The following indicators including operative time,intraoperative blood loss,postoperative wound area,wound healing time,hospital stay,anal continence function,incidence of complications and relapse rate within 1 year were observed and compared between the two groups.Results Compared with the control group,the operative time in the observation group was longer(t=2.483,P=0.016),the intraoperative blood loss was less(t=8.190,P=0.000),the postoperative wound area was smaller(t=24.696,P=0.000),and the wound healing time and hospital stay were shorter(t=3.280 and 2.369 respectively,P=0.002 and0.021 respectively),and all the differences between the two groups were statistically significant(P<0.05).The Wexner scores in the observation group at the time points of week 1 postoperation,month 1,3 and 6 postoperation were all markedly lower than that in the control group(t=5.292,3.248,6.330 and 7.031 respectively;P=0.000,0.002,0.000 and0.000 respectively),and the between-group comparisons of the Wexner scores at each time point all showed statistically significant differences(P<0.05).The incidence of complications and relapse rate in the observation group were both obviously lower than that in the control group(χ^2=4.694 and 5.121 respectively;P=0.030 and 0.024 respectively),and the differences were both statistically significant(P<0.05).Conclusion Compared with the incision-thread-drawing procedure,the ligation of the intersphincteric fistula tract in the treatment of high complex anal fistula can effectively reduce intraoperative blood loss,shorten postoperative wound healing time,protect the anal sphincter function,and decrease the incidence of complications and relapse rate,deserving to be promoted in clinical practice.