保留括约肌内口切除引流术治疗复杂性肛瘘的临床研究

Sphincter-preserving fistulectomy with internal opening resection and drainage seton in treating complex anal fistula

目的对比分析应用保留括约肌内口切除引流术与肛门括约肌间瘘管结扎术治疗复杂性肛瘘的临床效果。方法选择2016年1月至2018年1月在潮州市中心医院行手术治疗的114例复杂性肛瘘患者为研究对象,按照随机数字表法分为对照组(n=57,采用肛门括约肌间瘘管结扎术治疗),观察组(n=57,采用保留括约肌内口切除引流术治疗)。比较两组术后第1~7天疼痛积分差值,疼痛持续时间、创面愈合时间、手术时间、住院时间、术中出血量,术后1、3、6个月时肛门失禁程度评分和临床疗效。结果术后第1~3天,观察组患者的疼痛积分差值比对照组患者疼痛积分差值小,差异均有统计学意义(均P<0.05)。术后第4~7天,两组疼痛积分差值比较差异均无统计学意义(均P>0.05)。两组疼痛持续时间比较差异无统计学意义(P>0.05);观察组创面愈合时间、住院时间短于对照组,手术时间长于对照组、术中出血量多于对照组,差异均有统计学意义(均P<0.05)。术前,两组Wexner肛门失禁评分均为0分;术后1个月,观察组Wexner肛门失禁评分高于对照组,差异有统计学意义(P<0.05);术后3个月、术后6个月两组Wexner肛门失禁评分比较差异均无统计学意义(均P>0.05)。观察组临床总有效率为94.7%,对照组患者为80.7%,观察组总有效率高于对照组,差异有统计学意义(P<0.05)。结论复杂性肛瘘患者应用保留括约肌内口切除引流术治疗的效果确切,能够有效加快创面愈合,缩短疼痛持续时间,具有良好的临床应用与推广价值。

Objectives To compare the clinical effect of sphincter-preserving fistulectomy with internal opening resection and drainage seton,and ligation of the intersphincteric fistula tract in treating complex anal fistula.Methods A total of 114 pa?tients with complex fistula treated at Chaozhou Central Hospital between January 2016 and January 2018 were recruited and ran?domly assigned to the control group(n=57,patients received ligation of the intersphincteric fistula tract)and the treatment group(n=57,patients received sphincter-preserving fistulectomy with internal opening resection and drainage seton)according to the ran?dom number table.The following were compared between the two groups:pain score difference at 1 to 7 days after surgery,pain duration,wound healing time,operation time,intraoperative blood loss,Wexner score at 1,3,and 6 months after surgery,and clinical effectiveness.Results Pain scores difference at 1 to 3 days after surgery were significantly lower in the treatment group than in the control group(P<0.05).Pain scores difference at 4 to 7 days after surgery and pain duration did not differ be?tween the two groups(P>0.05).Compared with the control group,the treatment group had a significantly shorter wound healing time,shorter hospitalization time,longer operation time and more intraoperative blood loss(P<0.05).Both groups had a Wexner score of 0 before surgery.Wexner score at one month after surgery was significantly lower in the treatment group than in the control group(P<0.05).Wexner scores at 3 and 6 months after surgery did not differ between the two groups(P>0.05).Overall clinical effectiveness was 94.7%in the treatment group and 80.7%in the control group,with significant between-group differenc?es(P<0.05).Conclusion Sphincter-preserving fistulectomy with internal opening resection and drainage seton is effective in treat?ing complex anal fistula.It is associated with shorter wound healing time and pain duration.It has the potential to be widely used in clinical practice.