隧道式切除-最小化挂线术治疗复杂性肛瘘的临床研究

Clinical Study on Treatment of Complex Anal Fistula with“Tunnel Resection-Minimal Thread-Drawing”

目的:探讨“隧道式切除-最小化挂线术”治疗复杂性肛瘘的疗效。方法:选取复杂性肛瘘患者84例,将其随机分为对照组与试验组,每组42例,对照组行肛瘘切开挂线术,试验组行“隧道式切除-最小化挂线术”,观察并比较两组的创面面积及变化、纵径及减少率、创面生长情况(肉芽及分泌物)、肛瘘复发率等指标。结果:试验组总体有效率为95.24%,对照组为92.86%,差异无统计学意义(χ^(2)=0.213,P>0.05);而试验组的显效率高于对照组(78.57%vs 19.05%),差异有统计学意义(χ^(2)=29.779,P<0.05);试验组术后7、14d疼痛VAS评分分别为(4.21±0.77)分、(2.93±0.70)分,低于对照组的(5.24±0.75)分、(4.21±0.77)分,差异有统计学意义(P<0.05)。试验组术后1、21d创面面积分别(17.76±1.37)cm^(2)、(9.10±1.13)cm^(2),低于对照组的(23.23±2.93)cm^(2)、(14.23±1.84)cm^(2),差异有统计学意义(P<0.05)。结论:“隧道式切除-最小化挂线术”治疗复杂性肛瘘的疗效明确,创伤小,病程短,值得临床推广应用。

Objective To explore the curative effect of“tunnel resection-minimal thread-drawing”on complicated anal fistula.Methods A total of 84 patients with complex anal fistulas were collected.They were completely randomly divided into two groups:control group and test group.42 cases were selected for observation in each group.The control group underwent anal fistula incision and thread-drawing operation,and the test group underwent"tunnel resection-Minimize thread-drawing surgery".The wound area and changes,longitudinal diameter and reduction rate,wound growth(granulation and secretions),anal fistula recurrence rate and other indicators were observed.The clinical effects of the two groups were compared.Results In clinical observation,the two groupscompleted a total of 84 observation cases,and there were no cases of shedding.After reaching the treatment course,the overall curative effect of the experimental group was 95.24%and the control group was 92.86%,which the differences were not statistically significant(χ^(2)=0.213,P>0.05).The significant efficiency of the experimental group was 59.52%higher than that of the control group,which the difference was statistically significant.The significance(χ^(2)=29.779,P<0.05),pain VAS scores of the test group were(4.21±0.77)points,(2.93±0.70)points on the 7th and 14th day after operationrespectively,which were lower than those of the control group(5.24±0.75)points,(4.21±0.77)points,which the differences were statistically significant(P<0.05).The wound area of the experimental group was(17.76±1.37)cm^(2) and(9.10±1.13)cm^(2) on the 1st and 21st days after operationrespectively,which were significantly lower than those of the control group(23.23±2.93)cm^(2) and(14.23±1.84)cm^(2).The difference were statistically significant(P<0.05).Conclusion“Tunneling resection-minimal threaddrawing”is effective in the treatment of complicated anal fistula,and it will be widely used in the clinic for a certain period.