经括约肌间瘘管结扎术治疗低位单纯性肛瘘的临床研究

Ligation of intersphincteric fistula tract in treatment of low simple anal fistula

目的探讨经括约肌间瘘管结扎术(LIFT)治疗低位单纯性肛瘘患者的效果。方法收集2018年1月至2019年1月就诊于盘山县人民医院的单纯性肛瘘患者80例,随机数字表法分为观察组(LIFT治疗)与对照组(肛瘘切开术治疗),各40例。对照组男性24例,女性16例,年龄(40.46±5.87)岁;观察组男性23例,女性17例,年龄(40.83±5.78)岁。比较两组相关临床指标[创面愈合时间、术中出血量、术后1 d时视觉模拟评分法(VAS)评分、住院时间以及手术时间]、术前与术后1个月肛门功能[肛门失禁严重度指数(FISI)]以及术后不良反应发生情况。结果观察组手术时间(34.63±5.31)min,长于对照组的(21.59±4.35)min(P<0.001);观察组创面愈合时间(13.73±3.51)d,短于对照组的(21.13±2.49)d(P<0.001),观察组术后1 d时VAS(2.56±0.83)分,低于对照组的(3.38±0.84)分(P<0.001);观察组术中出血量(24.28±5.81)ml,低于对照组的(25.24±4.93)ml,但差异无统计学意义(P>0.05);观察组住院时间(8.11±1.37)d,短于对照组的(8.48±1.38)d,但差异无统计学意义(P>0.05)。观察组术后1个月FISI评分(0.74±0.35)分,低于术前的(4.62±0.91)分(P<0.001);对照组术后1个月FISI评分(2.67±1.02)分,低于术前的(4.75±0.94)分(P<0.001);且观察组术后1个月FISI评分低于对照组(P<0.001)。观察组术后并发症发生率5%(2/40),对照组10%(4/40)(P>0.05)。结论单纯性肛瘘患者采用LIFT治疗效果更佳,术后疼痛更轻微,更有利于创面愈合,同时也能促进肛门功能的恢复且有一定的安全性。

Objective To explore the effect of ligation of intersphincteric fistula tract(LIFT)for patients with low simple anal fistula.Methods Eighty patients with simple anal fistula who were treated in Panshan County People's Hospital from January 2018 to January 2019 were collected,and were divided into an observation group,treated by LIFT,and a control group,taking anal fistula incision,by the random number table method,with 40 cases in each group.There were 24 males and 16 females in the control group,with an age of(40.46±5.87).There were 23 males and 17 females in the observation group,with an age of(40.83±5.78).The related clinical indicators[(wound healing time,intraoperative blood loss,score of Visual Analogue Scale(VAS)1 day after surgery,hospital stay,and operation time)],anal function before and 1 month after the surgery[anal incontinence severity index(FISI)],and the occurrences of adverse reactions after the surgery were compared between these two groups.Results The operation time of the observation group was longer than that of the control group[(34.63±5.31)min vs.(21.59±4.35)min,P<0.001].The wound healing time of the observation group was shorter than that of the control group[(13.73±3.51)d vs.(21.13±2.49)d,P<0.001].The VAS score of the observation group was lower than that of the control group on the first day after the surgery[(2.56±0.83)vs.(3.38±0.84),P<0.001].The intraoperative blood loss of the observation group was lower than that of the control group[(24.28±5.81)ml vs.(25.24±4.93)ml],but the difference was not statistically significant(P>0.05).The length of stay in the observation group was shorter than that in the control group[(8.11±1.37)d vs.(8.48±1.38)d],but the difference was not statistically significant(P>0.05).The FISI score of the observation group 1 month after the operation was lower than that before the operation[(0.74±0.35)vs.(4.62±0.91),P<0.001];the FISI score of the control group 1 month after the operation was lower than that before operation[(2.67±1.02)vs.(4.75±0.94),P<0.001];and the FISI score of the observation group was lower than that of the control group 1 month after operation(P<0.001).The incidence of postoperative complications in the observation group(5%,2/40)was lower than that in the control group(10%,4/40)(P>0.05).Conclusion LIFT for patients with simple anal fistula has better results and less postoperative pain,is more conducive to wound healing,and can promote the recovery of anal function,with a certain degree of safety.