肛瘘切开联合肛门内外括约肌修补术治疗括约肌间瘘的疗效研究

Efficacy of anal fistulotomy combined with internal and external anal sphincter repair in treatment of intersphincteric fistula

目的观察肛瘘切开联合肛门内外括约肌修补术治疗括约肌间肛瘘的疗效。方法选取杭州市第三人民医院2020年1月1日至2021年6月30日接受手术治疗的300例括约肌间肛瘘患者为研究对象,其中采取肛瘘切开联合肛门内外括约肌修补术治疗150例,为观察组;单纯肛瘘切开150例,为对照组。比较两组患者手术情况、手术前后肛肠动力学指标以及随访半年后肛门失禁、锁孔畸形发生率及肛瘘复发率。结果与对照组比较,观察组患者创口愈合时间明显缩短(P<0.05);两组患者术中出血量、手术时间、疼痛评分、住院时间比较,差异均无统计学意义(均P>0.05)。术前两组患者肛管静息压、肛管最大收缩压、肛管最长收缩时间比较,差异均无统计学意义(均P>0.05);术后对照组患者上述肛肠动力学指标均明显降低(均P<0.05),而观察组变化不明显(均P>0.05),其中观察组上述肛肠动力学指标均明显高于对照组(均P<0.05)。与对照组比较,观察组患者肛门失禁、锁孔畸形发生率均明显降低(均P<0.05);两组患者肛瘘复发率比较,差异无统计学意义(P>0.05)。结论肛瘘切开联合肛门内外括约肌修补术治疗括约肌间肛瘘的有效性及安全性均较好,可在临床推广应用。

Objective To evaluate the efficacy of fistulotomy combined with internal and external sphincter repair in the treatment of intersphincter anal fistula.Methods Three hundred patients with intersphincter fistula who underwent surgical treatment in Hangzhou Third People's Hospital from January 2020 to June 2021 were enrolled.Among them,150 cases were treated by anal fistulotomy combined with internal and external sphincter repair(trial group),and 50 cases them were treated by fistulotomy only(control group).The operation time,intraoperation bleeding,length of hospital stay,healing time,anorectal dynamic indexes before and after operation,the incidence of anal incontinence and keyhole malformation,recurrence of anal fistula after half a year of follow-up were compared between two groups.Results Compared with the control group,the healing time in trial group was significantly shorter(P<0.05).There were no significant differences in intraoperatiion bleeding,operation time,pain score and length of hospital stay between the two groups(all P>0.05).There was no significant difference in anal resting pressure,maximum anal squeeze pressure and maximum anal squeeze time between the two groups before operation(all P>0.05).The above anorectal dynamic indexes in the control group decreased significantly after operation(all P<0.05);while there were no significant changes in the trial group(all P>0.05),which were significantly higher than those in the control group(all P<0.05).Compared with the control group,the incidence of anal incontinence and keyhole malformation in the trial group were significantly lower(all P<0.05).There was no significant difference in the recurrence rate of anal fistula between the two groups(P>0.05).Conclusion Fistulotomy combined with internal and external anal sphincter repair is effective and safe in the treatment of sphincter fistula,which is worth promoting in clinical practice.