经括约肌间瘘管结扎术与肛瘘切开挂线术治疗复杂肛瘘的效果

Effect of ligation of intersphincter fistula and incision and thread hanging of anal fistula in the treatment of complex anal fistula

目的分析经括约肌间瘘管结扎术(LIFT术)与肛瘘切开挂线术治疗复杂肛瘘的效果及对肛门功能的影响。方法选取2017年7月~2018年11月北京市肛肠医院收治的复杂肛瘘患者92例,采用随机数字表法分为研究组和对照组,每组46例,研究组采取LIFT术,对照组采取传统切开挂线术。比较两组围术期相关指标,手术效果(治愈率、并发症发生率及术后6个月内复发率),以及对肛门功能的影响(采用盆底肌电图和肛门直肠压力测定判定肛门功能,采用Wexner评分标准判定肛门失禁程度)。结果围术期指标:研究组术中出血量、创面面积、术后7 d视觉模拟评分(VAS)、创面愈合时间均显著小于对照组(P <0.05);两组手术时间比较,差异无统计学意义(P> 0.05)。手术效果:研究组手术并发症发生率显著低于对照组(P <0.05),两组复发率、治愈率比较,差异均无统计学意义(均P> 0.05)。肛门功能:术后3个月,研究组耻骨直肠肌、内括约肌、外括约肌轻微收缩时动作电位时限,肛管静息压、最大收缩压均显著高于对照组(P <0.05);研究组Wexner评分显著低于对照组(P <0.05)。结论 LIFT术与切开挂线术治疗复杂肛瘘各有利弊,前者创伤小、并发症少、对肛门功能的影响小,后者手术效果好,但针对于复杂肛瘘切除后复发率仍然较高,临床中应根据具体情况进行选择。

Objective To analyze the effect of ligation of intersphincteric fistula tract(LIFT)technique and incision and thread drawing of anal fistula in treatment of complex anal fistula and its influence on anal function.Methods A total of 92 patients with complex anal fistula and who treated in Beijing Anorectal Hospital from July 2017 to November2018 were selected,and the patients were divided into study group and control group by random number table method,with 46 cases in each group.The study group used LIFT surgery,and the control group used traditional incision and thread hanging surgery.The perioperative related indexes,surgical effect(cure rate,complication rate and recurrence rate after operation for 6 months)and the influence on anal function(anal function were determined by the pelvic floor electromyography and anorectal pressure and the degree of anal incontinence were determined by the Wexner score)were compared between the two groups.Results Perioperative indexes:the bleeding volume,wound area,visual analogue scale(VAS)7 d after surgery and wound healing time in the study group were significantly shorter than those in the control group(P<0.05);there was no significant difference between the two groups in operating time(P>0.05).Surgical effect:the incidence of surgical complications in the study group was significantly lower than that in the control group(P<0.05).There was no significant difference in recurrence rate and cure rate between the two groups(P>0.05).Anal function:three months after operation,the time limit of action potential,anal resting pressure and maximum systolic pressure in the study group were significantly higher than those in the control group(P<0.05),and the Wexner score in the study group was significantly lower than that in the control group(P<0.05).Conclusion LIFT surgery and incision and thread hanging surgery have both advantages and disadvantages in the treatment of complex anal fistula.The former has little trauma,few complications and little influence on anal function,while the latter has a good surgical effect,but the recurrence rate is still high after the resection of complex anal fistula,which should be selected according to the specific situation in clinical practice.