切开挂线术联合肛洗一号熏洗治疗高位肛瘘的临床研究

Clinical Study on the Treatment of High Anal Fistula by Incision and Thread Hanging Combined with Anal Washing No.1 Fumigation

目的:观察切开挂线术联合肛洗一号熏洗治疗高位肛瘘的临床疗效和安全性。方法:观察142例高位肛瘘患者,其中观察组71例采用切开挂线术联合肛洗一号熏洗,对照组71例采用切开挂线术联合聚维酮碘溶液坐浴,比较两组的疗效、住院时间、创面愈合时间、术后疼痛评分、术后并发症、不良反应和手术后6个月复发率。结果:此次研究过程中脱落9例,共完成试验133例,其中观察组68例,对照组65例。两组患者的疗效、术后并发症发生率(术后出血、尿潴留、肛门失禁)、不良反应(皮肤过敏、肛周湿疹)和手术后6个月复发率相比差异均无统计学意义[97.1%vs 95.4%,χ2=0.288,P=0.866;1.5%vs 3.1%,χ2=0.389,P=0.614;5.9%vs 7.7%,χ2=0.173,P=0.741;5.9%vs 4.6%,χ2=0.107,P=1.0;2.9%vs 4.6%,χ2=0.257,P=0.676;4.4%比3.1%,χ2=0.164,P=1.0;2.9%vs 4.6%,χ2=0.257,P=0.676];而观察组的住院时间和创面愈合时间均较短[(8.22±1.84)d vs(8.97±2.39)d,t=-2.016,P=0.046;(42.38±7.98)d vs(45.40±8.99)d,t=-2.049,P=0.042],术后第2日和手术后1周疼痛均较轻[(3.51±0.92)分vs(3.86±0.97)分,t=-2.118,P=0.036;(2.44±0.87)分vs(2.83±0.95)分,t=-2.475,P=0.015],术后创缘水肿发生率低(2.9%vs 12.3%,χ2=4.193,P=0.041),差异均具有统计学意义。结论:中药肛洗一号熏洗可以促进肛瘘切开挂线术后创面愈合、减轻术后疼痛、预防和减少创缘水肿,是一种安全有效的治疗方法。

Objective To observe the clinical efficacy and safety of incision and thread drawing combined with anal washing No.1 fumigation in the treatment of high anal fistula.Methods To observe 142 cases of high anal fistula,71 cases of high anal fistula in the observation group were treated by incision and thread hanging combined with No.1 fumigation of anal washing,71 cases of high anal fistula in the control group were treated by incision and thread hanging combined with povidone iodine solution sitz bath.The curative effect,hospitalization time,wound healing time,postoperative pain score,postoperative complications and adverse reactions were compared.Six months after the operation,we observed the recurrence rate of the two groups.Results In the course of this study,9 cases of abscission and 133 cases of experiment were completed,including 68 cases in the observation group and 65 cases in the control group.There was no significant difference in the curative effect,postoperative complications(postoperative bleeding,urinary retention,anal incontinence),adverse reactions(skin allergy,perianal eczema)and recurrence rate after 6 months of operation between the two groups,[97.1%vs 95.4%,χ2=0.288,P=0.866;1.5%vs.3.1%,χ2=0.389,P=0.614;5.9%vs 7.7%,χ2=0.173,P=0.741;5.9%vs 4.6%,χ2=0.107,P=1.0;2.9%vs.4.6%,χ2=0.257,P=0.676;4.4%vs 3.1%,χ2=0.164,P=1.0;2.9%vs 4.6%,χ2=0.257,P=0.676].The hospitalization time and wound healing time of the observation group were shorter[(8.22±1.84)d vs(8.97±2.39)d,t=-2.016,P=0.046;(42.38±7.98)d vs(45.40±8.99)d,t=-2.049,P=0.042].On the second day and one week after operation,the pain was mild[(3.51±0.92)points vs.(3.86±0.97)points,t=-2.118,P=0.036;(2.44±0.87)points vs(2.83±0.95)points,t=-2.475,P=0.015],and the incidence of postoperative edema was lower[2.9%vs 12.3%,χ2=4.193,P=0.041].Conclusion The traditional Chinese medicine of anal washing No.1 fumigation can promote wound healing,relieve postoperative pain,prevent and reduce wound edema after anal fistula incision and thread hanging operation.This is a safe and effective treatment method,which is worthy of clinical application.