改良经括约肌间瘘管结扎术治疗单纯性括约肌型肛瘘的临床效果评价

Clinical evaluation of modified intersphincter fistula ligation in the treatment of simple sphincter anal fistula

目的 评价单纯性括约肌型肛瘘治疗中改良经括约肌间瘘管结扎(LIFT)术的临床效果。方法 采用回顾性分析方法,以2019年1月至2021年12月海南省人民医院收治入院的76例单纯性括约肌型肛瘘患者为研究对象,根据手术方式不同分为对照组(n=38)与研究组(n=38)。研究组行改良LIFT术治疗,对照组行常规LIFT术治疗。比较两组患者手术时间、术后愈合时间、手术前后疼痛评分、Wexner肛门失禁评分、肛管直肠压力(肛管最大收缩压、肛管静息压)、生活质量评分、总有效率、并发症(肛门失禁、切口感染、尿潴留)发生率。结果 研究组患者的手术时间、术后愈合时间为(1.31±0.36) h、(10.26±2.43) d,明显短于对照组[(1.62±0.43) h、(16.71±4.58) d],差异均有统计学意义(P <0.05)。术后1个月,两组患者Wexner肛门失禁评分均较术前明显降低,差异均有统计学意义(P <0.05);而两组患者Wexner肛门失禁评分比较,差异无统计学意义(P> 0.05)。术后1个月,两组患者肛管直肠压力与术前相比,且两组术后1个月肛管直肠压力比较,差异均无统计学意义(P> 0.05)。术后1个月,两组患者疼痛评分均较术前明显下降,且研究组术后较对照组更低,差异均有统计学意义(P <0.05)。术后1个月,两组患者生活质量评分均较术前明显升高,且研究组术后较对照组更高,差异均有统计学意义(P <0.05)。研究组总有效率为97.36%,高于对照组(78.95%),并发症发生率为2.64%,低于对照组(21.05%),差异均有统计学意义(P <0.05)。结论 单纯性括约肌型肛瘘治疗中改良LIFT术的临床疗效显著,可提升患者治愈率及生活质量,缩短术后愈合时间,还可进一步减少其疼痛程度及并发症。

Objective To study the clinical effect of improved trans-sphincteric fistula ligation( LIFT) in the treatment of simple sphincteric anal fistula.Methods A retrospective analysis was conducted to study 76 patients with simple sphincter anal fistula who were admitted to Hainan Provincial People’s Hospital from January 2019 to December 2021 and were divided into control group( n = 38) and study group( n =38) according to surgical methods.The control group received conventional LIFT surgery,and the study group received modified LIFT surgery.The operation time,postoperative healing time,Wexner anal incontinence score,anal canal pressure( maximum systolic pressure of the anal canal,resting pressure of the anal canal),pain score,quality of life score before and after surgery,total effective rate and complications( anal incontinence,incision infection,urinary retention) incidence were compared between the two groups of patients.Results The operation time and postoperative healing time of the patients in the study group were( 1.31 ± 0.36) h,( 10.26 ± 2.43) d,which were significantly shorter than those in the control group [( 1.62 ± 0.43) h,( 16.71 ± 4.58) d],the differences were all There was statistical significance( P < 0.05).One month after operation,the Wexner anal incontinence scores of the two groups were significantly lower than those before operation,and the difference was statistically significant( P < 0.05).There was no significant difference in the postoperative Wexner anal incontinence score between the two groups( P > 0.05).One month after operation,there was no significant difference in the anorectal pressure between the two groups compared with the preoperative one,and between the two groups at one month after operation( P > 0.05).One month after operation,the pain scores of the two groups were significantly decreased compared with those before operation,and the research group was lower than the control group after operation,the differences were statistically significant( P < 0.05).One month after operation,the quality of life scores of the two groups were significantly higher than those before operation,and the study group was higher than the control group after operation,the difference being statistically significant( P < 0.05).The total effective rate of the study group was 97.36%,which was higher than that of the control group( 78.95%),and the incidence of complications was 2.64%,which was lower than that of the control group( 21.05%),and the differences were statistically significant( P < 0.05).Conclusion Improved LIFT has significant efficacy in the treatment of simple sphincter anal fistula,which can improve the cure rate and quality of life of patients,shorten postoperative healing time,and further reduce the degree of pain and complications.