内括约肌后正中切断联合肛窦切开引流治疗慢性肛裂患者的临床研究

Clinical Study on the Treatment of Patients with Chronic Anal Fissure by Posterior Median Incision of Internal Sphincter Combined with Incision and Drainage of Anal Sinus

目的探讨内括约肌后正中切断联合肛窦切开引流治疗慢性肛裂患者的临床疗效。方法选取2017年8月至2019年8月深圳市龙岗区第三人民医院收治的46例慢性肛裂的患者,按照随机数字表法分为研究组和对照组,每组23例。对照组采取肛门内括约肌侧切术,研究组采取内括约肌后正中切断术联合肛窦切开引流术,分析比较两组患者的治疗效果、手术情况、术后视觉模拟(VAS)评分及术后并发症。结果研究组总有效率高于对照组,研究组创面愈合时间明显长于对照组(P<0.05),但手术时间和住院时间比较差异无统计学意义(P>0.05);研究组术后1 d,术后3 d,术后7 d VAS评分均低于对照组,差异有统计学意义(P<0.05),研究组术后并发症总发生率为8.70%低于对照组为34.78%,(P<0.05)。结论两种手术方式在治疗慢性肛裂患者上,均有一定的临床意义,但内括约肌后正中切断联合肛窦切开引流可直接切除肛裂病变组织,能有效扩大肛门口径,减轻患者疼痛感觉,减少患者术后并发症。

Objective To investigate the clinical effect of posterior median internal sphincter excision combined with anal sinus incision and drainage in the treatment of chronic anal fissure.Methods A total of 46 patients with chronic anal fissure admitted to the Third People's Hospital of Shenzhen Longgang District from August 2017 to August 2019 were selected and randomLy divided into study group and control group,with 23 cases in each group.The control group was treated with lateral resection of internal anal sphincter,and the study group was treated with posterior median resection of internal sphincter combined with incision and drainage of anal sinus.The therapeutic effect,operation condition,postoperative visual analogue scale(VAS)score and postoperative complications of the two groups were analyzed and compared.Results The total effective rate of the study group was higher than that of the control group,and the wound healing time of the study group was significantly longer than that of the control group(P<0.05),but there was no significant difference in the operation time and hospitalization time(P>0.05);the study group was 1 d,3 d,7 d after operation VAS score was lower than that of the control group,the difference was statistically significant(P<0.05).The total incidence of postoperative complications in the study group was 8.70%,which was lower than that in the control group 34.78%(P<0.05).Conclusion The two surgical methods in the treatment of chronic anal fissure patients,both have certain clinical significance,but the posterior median internal sphincter incision combined with anal sinus incision and drainage can directly remove the anal fissure lesion tissue,effectively expand the anal caliber,reduce the pain feeling of patients,and reduce postoperative complications.