高频电刀电灼加肛管内点状结扎疣体联合肛管松解术治疗肛管尖锐湿疣的疗效观察

High-frequency electrocautery and point-by-point ligation of anal warts combined with anal canal relaxation for treating condyloma acuminatum of the anal canal

目的 观察高频电刀电灼加肛管内点状结扎疣体联合肛管松解术治疗肛管尖锐湿疣的临床疗效及其对肛门形态及功能的影响。方法 回顾性分析徐州医科大学附属医院肛肠科2015年1月至2021年4月采用高频电刀电灼加肛管内点状结扎疣体联合肛管松解术治疗81例肛管尖锐湿疣患者的临床资料。分别于术后6周、12周、24周评价患者的疗效,于术前及术后(6周、12周、24周)评价患者的肛门形态及功能(肛门狭窄程度、肛门失禁程度、排粪顺畅度)。结果 81例患者术后均治愈,疣体切除率为100%;术后(6周、12周、24周)的复发率分别为2.5%、3.7%、9.8%;随访期间出现复发即使用高频电刀去除新生疣体,并嘱患者涂抹重组人α-2b干扰素凝胶,末次治疗后6个月,复发患者均治愈。患者不同时点的肛门狭窄程度评分比较差异无统计学意义(P>0.05);患者不同时点的肛门失禁程度评分比较差异有统计学意义(P<0.05),术后(6周、12周、24周)的肛门失禁程度评分均低于术前,术后12周、24周的肛门失禁程度评分均低于术后6周(均P<0.05);患者不同时点的排粪顺畅度评分比较差异有统计学意义(P<0.05),术后(6周、12周、24周)的排粪顺畅度评分均低于术前(均P<0.05)。结论 高频电刀电灼加肛管内点状结扎疣体联合肛管松解术治疗肛管尖锐湿疣具有一定的优势,在获得较为理想的疗效的同时,对肛门形态及功能的影响较小,具有临床推广的价值。

Objectives To investigate the clinical effect of high-frequency electrocautery and point-by-point ligation of anal warts combined with anal canal relaxation for treating condyloma acuminatum of the anal canal and its effect on anal morphology and function. Methods This was a retrospective analysis of 81 patients with condyloma acuminatum of the anal canal who were treated with high-frequency electrocautery and point-by-point ligation of anal warts combined with anal canal relaxation at the Department of Anorectal Diseases, Affiliated Hospital of Xuzhou Medical University, between January 2015 and April 2021. Clinical effectiveness was evaluated at 6, 12, and 24 weeks after surgery. Anal morphology and function(degree of anal stricture, degree of anal incontinence, and smoothness of defecation) were evaluated before and at 6, 12, and 24 weeks after surgery. Results All patients were considered cured after surgery with 100% resection of warts removal. The recurrence rate was 2.5%, 3.7%, and 9.8% at 6, 12, and 24 weeks after surgery. Patients with recurrence received immediate warts removal with high-frequency electric energy and recombinant human interferon α-2b topical gel;all patients with recurrence were considered cured 6 months after the last treatment. The degree of anal stricture did not differ significantly(P>0.05) at different time points. The degree of anal incontinence after surgery(6, 12, and 24 weeks) was significantly lower than before surgery, and the degree of anal incontinence at 12 and 24 weeks was significantly lower than that at 6 weeks after surgery(P<0.05). There were significant differences in the degree of smoothness of defecation at different time points(P<0.05), and the degree of smoothness at 6, 12, and 24weeks after surgery was significantly lower than before surgery(P<0.05). Conclusion High-frequency electrocautery and pointby-point ligation of anal warts combined with anal canal relaxation have a certain advantage for treating condyloma acuminatum of the anal canal. It has satisfactory treatment effect while having little impact on anal morphology and function. It has the potential for wider clinical application.