多切口拖管术治疗高位马蹄型肛瘘的临床观察

Clinical observation on tube-dragging therapy with multiple incisions in the treatment of high horseshoe anal fistula

目的:评价多切口拖管术治疗高位马蹄型肛瘘的临床疗效。方法:纳入72例高位马蹄型肛瘘患者,随机分为治疗组和对照组,每组各36例。治疗组患者采用多切口拖管术治疗,对照组患者采用传统切开挂线术治疗。比较两组患者的创面愈合时间;术后第3、7、14天,评价两组患者的创面疼痛、渗液、水肿评分;术后3个月,评价并比较两组患者的肛门功能指检、肛门失禁评分及临床疗效。结果:研究过程中,对照组1例患者脱落,最终治疗组36例、对照组35例患者纳入统计分析。①术后3个月,治疗组的临床总有效率为97.2%,对照组为94.3%,两组临床疗效比较,差异无统计学意义(P>0.05)。②治疗组患者的创面愈合时间较对照组明显缩短(P<0.05)。③术后第7、14天,治疗组患者的创面疼痛、渗液评分均低于对照组(P<0.05,P<0.01);术后,两组患者的创面水肿评分比较,差异无统计学意义(P>0.05)。④术后3个月,两组患者的肛门功能指检评分比较,差异无统计学意义(P>0.05);治疗组患者的肛门失禁评分较对照组明显降低(P<0.05)。结论:与传统切开挂线术相比,多切口拖管术治疗高位马蹄型肛瘘可减轻患者术后并发症、缩短愈合时间、保护肛门括约肌功能,值得在临床推广应用。

Objective:To evaluate the clinical efficacy of tube-dragging therapy with multiple incisions in the treatment of high horseshoe anal fistula.Methods:A total of 72 patients with high horseshoe anal fistula were included and randomly divided into the treatment group and control group,36 cases in each group.The patients in the treatment group were treated with tube-dragging therapy with multiple incisions,and the patients in the control group were treated with traditional incision and thread-drawing therapy.The wound healing time of the two groups was compared.On the 3rd,7th and 14th days after operation,the scores of wound pain,effusion and edema in the two groups were evaluated.Three months after operation,the scores of anal function and incontinence,and the clinical efficacy were evaluated and compared.Results:In the course of study,one patient in the control group fell off,finally 36 cases in the treatment group and 35 cases in the control group were included for the statistical analysis.①Three months after operation,the total clinical effective rate was 97.2%in the treatment group and 94.3%in the control group,with no statistically significant difference between the two groups(P>0.05).②The wound healing time in the treatment group was significantly shorter than that in the control group(P<0.05).③On the 7th and 14th days after operation,the scores of wound pain and effusion in the treatment group were lower than those in the control group(P<0.05,P<0.01).After operation,there was no statistically significant difference in the score of wound edema between the two groups(P>0.05).④Three months after operation,there was no statistically significant difference in the score of anal function between the two groups(P>0.05),and the score of anal incontinence in the treatment group was significantly lower than that in the control group(P<0.05).Conclusion:Compared with traditional incision and thread-drawing therapy,tube-dragging therapy with multiple incisions can reduce the postoperative complication,shorten the healing time and protect the anal sphincter function in the treatment of high horseshoe anal fistula,which is worth popularizing and applying in clinic.