肛瘘镜下直肠黏膜环切手术治疗肛瘘疗效分析

Efficacy of rectal mucosal circumcision with video-assisted anal fistula treatment for patients with anal fistula

目的分析肛瘘镜下直肠黏膜环切手术治疗肛瘘的疗效。方法将2017年6月至2020年6月秦皇岛市第一医院收治的126例高位肛瘘患者采用随机抽样法分为常规开放手术组(开放组)和肛瘘镜下直肠黏膜环切手术组(肛瘘镜组),每组63例。比较两组患者的出血量、手术时间、术后首次排便时间、术后正常进食时间、术后疼痛评分、住院时间,手术前后的肛管高压带长度、直肠静息压、肛管静息压、肛管最大收缩压,不同时间血清可溶性髓样细胞触发受体-1(sTREM-1)、可溶性细胞间黏附分子-1(sICAM-1)、CRP及基质金属蛋白酶-3(MMP-3)水平,手术后排便情况,近期临床疗效,尿潴留、肛周感染、术后出血、直肠狭窄、肛瘘复发等并发症的总发生率。结果开放组患者的出血量、手术时间、术后疼痛评分和住院时间均高于肛瘘镜组,差异均有统计学意义(均P<0.05);术后两组患者的肛管高压带长度、直肠静息压、肛管静息压、肛管最大收缩压均较术前降低,且开放组均低于肛瘘镜组,差异均有统计学意义(均P<0.05);术后两组患者的血清sTREM-1、sICAM-1、CRP及MMP-3水平较术前均有升高,且开放组均高于肛瘘镜组,差异均有统计学意义(均P<0.05);开放组患者自然排便率为60.32%,低于肛瘘镜组的80.95%;开放组患者排便困难率为19.05%,肛瘘镜组为0;开放组患者的总治愈率为76.19%,低于肛瘘镜组的95.24%;开放组患者的尿潴留、肛周感染、术后出血、直肠狭窄、肛瘘复发的总发生率高于肛瘘镜组,差异均有统计学意义(均P<0.05)。结论常规开放手术、肛瘘镜下直肠黏膜环切手术对于肛瘘患者均有一定的临床疗效,但肛瘘镜下直肠黏膜环切手术可减少出血量,缩短手术时间,保护肛门括约肌功能,改善炎症反应,促进术后排便,缩短康复时间,改善临床疗效,减少并发症发生率,安全性较佳。

Objective To evaluate the efficacy of rectal mucosal circumcision with video-assisted anal fistula treatment(VAAFT)for patients with anal fistula.Methods A total of 126 patients with high anal fistula admitted in Qinhuangdao First Municipal Hospital from June 2017 to June 2020 were randomly assigned in two groups with 63 cases in each group:the rectal mucosa circumcision was performed by conventional open surgery(control group)or by VAAFT(study group).The bleeding volume,operation time,first defecation after operation,normal diet after operation,postoperative pain score,length of hospital stay,length of anal canal high pressure zone before and after operation,rectal resting pressure,anal canal resting pressure,anal canal maximum systolic pressure,short-term clinical efficacy,incidence of urinary retention,perianal infection,postoperative bleeding,rectal stenosis,and anal fistula recurrence were compared between two groups;the serum soluble triggering receptor expressed on myeloid cell-1(sTREM-1),soluble intercellular adhesion molecule-1(sICAM-1),C-reactive protein(CRP)and matrix metalloproteinase-3(MMP-3)levels were measured before and after surgery in two groups.Results The bleeding volume and postoperative pain score were lower,the operation time and length of hospital stay were shorter in study group than those in control group.The functional indexes of anal sphincter of patients after operation were significantly lower than those before operation in both groups(all P<0.05).The length of anal high pressure zone,rectal resting pressure,anal resting pressure and anal maximum systolic pressure of patients in study group were higher than those in control group.The levels of serum sTREM-1,sICAM-1,CRP and MMP-3 were significantly increased after operation in both groups(all P<0.05),while the levels in study group were lower than those in control group.The natural defecation rate in the study group was significantly higher than that in control group(80.95%vs.60.32%,P<0.05),and the defecation difficulty rate in the study group was lower than that in control group(0 vs.19.05%,P<0.05).The total cure rate in the study group was higher than that in control group(95.24%vs.76.19%,P<0.05).The total incidence of urinary retention,perianal infection,postoperative bleeding,rectal stenosis,and anal fistula recurrence in study group was significantly lower than those in the control group(all P<0.05).Conclusion Compared to routine open surgery of rectal mucosa circumcision for patients with anal fistula,the video-assisted anal fistula treatment can reduce bleeding,shorten operation time,protect anal sphincter function,alleviate inflammatory response,promote postoperative defecation,shorten recovery time,improve clinical efficacy,reduce the incidence of complications and have better safety.