经括约肌间瘘管切除术治疗肛瘘患者的临床研究

Clinical study on the treatment of anal fistula by transsphincter fistulectomy

目的探讨经括约肌间瘘管切除术治疗肛瘘患者的临床效果。方法选取舟山医院2016年3月至2020年3月收治的肛瘘患者73例为观察对象,采用随机数字表法分为观察组(38例)与对照组(35例)。对照组行传统肛瘘切开挂线引流术,观察组行经括约肌间瘘管切除术。比较两组手术时间、创面愈合时间和住院时间,术后24 h、48 h视觉模拟评分法(VAS)评分,手术并发症,术前和术后3个月肛门括约肌功能改善情况。结果观察组手术时间[(49.83±7.67)min]、创面愈合时间[(20.78±3.54)d]和住院时间[(5.31±1.27)d]均短于对照组[(62.31±5.45)min、(25.87±3.10)d、(7.78±1.32)d],差异均有统计学意义(t=8.063、6.512、8.133,均P<0.05)。观察组VAS评分术后24 h[(2.43±0.64)分]、48 h[(1.21±0.36)分]均低于对照组[(3.87±1.23)分、(2.83±0.97)分],差异均有统计学意义(t=6.347、9.607,均P<0.05)。观察组并发症发生率[5.26%(2/38)]低于对照组[28.57%(10/35)],差异有统计学意义(χ^(2)=7.206,P<0.05)。结论经括约肌间瘘管切除术治疗肛瘘临床效果良好,可减轻患者疼痛,且对患者肛门括约肌功能影响小,具有创新性和科学性。

Objective To investigate the clinical effect of transsphincter fistulectomy in the treatment of anal fistula.Methods Seventy-three patients with anal fistula who received treatment in Zhoushan Hospital from March 2016 to March 2020 were included in this study.They were randomly assigned to undergo either conventional incision combined with thread-drawing drainage(control group,n=35)or transsphincter fistulectomy(observation group,n=38).Operative time,wound healing time,length of hospital stay,Visual Analogue Scale(VAS)score 24 and 48 hours after surgery,complications,the improvement in anal sphincter function before and 3 months after surgery were compared between the two groups.Results Operative time,wound healing time and length of hospital stay in the observation group were(49.83±7.67)minutes,(20.78±3.54)days and(5.31±1.27)days,which were significantly shorter than those in the control group[(62.31±5.45)minutes,(25.87±3.10)days,(7.78±1.32)days,t=8.063,6.512,8.133,all P<0.05].The VAS score 24 and 48 hours after surgery in the observation group were(2.43±0.64)points and(1.21±0.36)points,respectively,which were significantly lower than those in the control group[(3.87±1.23)points,(2.83±0.97)points,t=6.347 and 9.607,both P<0.05].The incidence of complication in the observation group was significantly lower than that in the control group[5.26%(2/38)vs.28.57%(10/35),χ^(2)=7.206,P<0.05].Conclusion Transsphincter fistulectomy in the treatment of anal fistula has good therapeutic effects,can reduce pain and has little impact on the function of anal sphincter.It is innovative and scientific.