微创侧方内括约肌松解术联合中药坐浴在慢性肛裂患者中的应用

Application of minimally invasive lateral internal sphincterolysis combined with traditional Chinese medicine hip bath in patients with chronic anal fissure

目的探讨微创侧方内括约肌松解术联合中药坐浴在慢性肛裂患者中的应用效果。方法选择2019年9月至2020年9月东莞市凤岗医院收治的60例慢性肛裂患者进行研究,按随机数表法分为观察组和对照组各30例。对照组患者采用传统肛裂切除术联合中药坐浴治疗,观察组患者采用微创侧方内括约肌松解术联合中药坐浴治疗,两组患者术后连续中药坐浴治疗14 d。比较两组患者术后14 d的临床疗效、围术期情况、术前及术后1 d、3 d、7 d、14 d时的视觉模拟评分法(VAS)评分、术前及术后1个月时的简明健康状况量表(SF-36)变化,并比较术后并发症发生情况。结果术后14 d,观察组患者的临床治疗总有效率为93.33%,明显高于对照组的73.33%,差异有统计学意义(P<0.05);观察组患者术中出血量、创面愈合时间、住院时间分别为(2.18±0.51)mL、(14.74±2.50)d、(5.20±0.71)d,明显少(短)于对照组的(5.09±0.76)mL、(17.91±2.19)d、(7.16±1.08)d,差异均有统计学意义(P<0.05);观察组患者术后1 d、3 d、7 d、14 d时的VAS评分分别为(4.45±0.56)分、(3.49±0.49)分、(2.64±0.36)分、(1.60±0.37)分,明显低于对照组的(4.81±0.50)分、(4.42±0.51)分、(3.22±0.57)分、(2.18±0.23)分,差异均有统计学意义(P<0.05);观察组患者术后1个月的SF-36评分为(89.40±5.71)分,明显高于对照组的(82.53±6.02)分,差异有统计学意义(P<0.05);观察组患者术后并发症总发生率为6.67%,明显低于对照组的26.67%,差异有统计学意义(P<0.05)。结论微创侧方内括约肌松解术联合中药坐浴治疗慢性肛裂可有效促进患者术后恢复、缓解疼痛、提高生活质量,临床治疗效果明显,值得推广应用。

Objective To study the application effect of minimally invasive lateral internal sphincterolysis com-bined with traditional Chinese Medicine hip bath in patients with chronic anal fissure.Methods A total of 60 patients with chronic anal fissure admitted to Fenggang Hospital of Dongguan city from June 2019 to June 2020 were selected for the study.They were divided into the observation group and the control group by random number table,with 30 pa-tients in each group.The control group was treated with traditional anal fissure resection combined with traditional Chi-nese medicine hip bath,while the observation group patients was treated with minimally invasive lateral internal sphincter release combined with traditional Chinese medicine hip bath,both for 14 days.The clinical efficacy,perioperative condi-tion,the changes of the visual analogue score(VAS)score before operation and 1 day,3 days,7 days and 14 days after op-eration,and the SF-36 before operation and 1 month after operation were compared between the two groups,and the inci-dence of postoperative complications was compared.Results After operation 14 days,the total effective rate of clinical treatment in the observation group was 93.33%,which was significantly higher than 73.33%of the control group(P<0.05).The intraoperative blood loss,wound healing time and hospital stay in the observation group were(2.18±0.51)mL,(14.74±2.50)d,(5.20±0.71)d,which were significantly less(shorter)than(5.09±0.76)mL,(17.91±2.19)d,(7.16±1.08)d of the control group(P<0.05).The VAS scores at after operation 1 day,3 days,7 days and 14 days in the observation group were(4.45±0.56)points,(3.49±0.49)points,(2.64±0.36)points,(1.60±0.37)points,which were significantly lower than(4.81±0.50)points,(4.42±0.51)points,(3.22±0.57)points,(2.18±0.23)points of the control group(P<0.05).The SF-36 score at 1 month after operation in the observation group was(89.40±5.71)points,which was significantly higher than(82.53±6.02)points of the control group(P<0.05).The total incidence of postoperative complications in the observation group was 6.67%,which was significantly lower than 26.67%in the control group(P<0.05).Conclusion Minimally in-vasive lateral internal sphincter release combined with traditional Chinese medicine hip bath in the treatment of chronic anal fissure patients is obvious effect,which can effectively promote postoperative recovery,relieve pain,improve the quality of life,while the clinical effect is obvious.It is worthy of popularization and application.