轻挂实切术治疗高位后马蹄形肛瘘的临床效果观察

Effectiveness of loose seton resection for treating high posterior horseshoe anal fistula

目的探讨轻挂实切术治疗高位后马蹄形肛瘘的临床效果。方法回顾性分析2020年4月至2021年2月在南京中医药大学常熟附属医院行轻挂实切术治疗的38例高位后马蹄形肛瘘患者的临床资料。比较手术前后静息相、提肛相及力排相的肛直角、肛管直肠压力和患者的肛门功能情况,评价该术式的临床疗效。结果本研究共纳入38例患者,治愈37(97.4%)例,显效1(2.6%)例,术后随访3个月无复发。术后,静息相及提肛相的肛直角均较术前减小(均P<0.05);力排相的肛直角与术前比较差异无统计学意义(P>0.05);肛管最大收缩压及舒张压均较术前降低(均P<0.05);肛管静息压及括约肌功能长度与术前比较差异均无统计学意义(均P>0.05);Wexner肛门失禁评分与术前比较差异无统计学意义(P>0.05)。结论轻挂实切术治疗高位后马蹄形肛瘘疗效良好,通过勒割挂线刺激组织促使肛直角变小,对肛门功能影响较小。

Objectives To investigate the effectiveness of loose seton resection for treating high posterior horseshoe anal fistula.Methods This was a retrospective analysis of 38 patients with high posterior horseshoe anal fistula who received loose seton re⁃section at the Changshu Hospital—Affiliated Hospital to Nanjing University of Chinese Medicine between April 2020 and Febru⁃ary 2021.To determine the effectiveness of this procedure,the followings were compared before and after surgery:anal angle during the resting phase,elevation phase,and forced discharge phase,anorectal pressure,and patients’anal function.Results Thirty-eight patients were included;37(97.4%)were cured,and the procedure was considered significantly effective in one pa⁃tient(2.6%).Patients were followed up for 3 months,and no recurrence was reported.Compared with pre-surgery,anal angle dur⁃ing the resting phase and elevation phase decreased significantly after surgery(P<0.05),while anal angle during forced discharge phase remained unchanged after surgery(P>0.05).Compared with pre-surgery,anal maximum systolic and diastolic pressure de⁃creased significantly after surgery(P<0.05),while anal resting pressure and functional length of sphincter remained unchanged af⁃ter surgery(P>0.05).Wexner anal incontinence score did not change significantly before and after the surgery(P>0.05).Conclusion Loose seton resection is effective for treating high posterior horseshoe anal fistula.It lowers the anal angle as a result of stimulations and resection via gradual tightening of the seton.It also has little impact on anal function.