改道挂线术与切开挂线术治疗括约肌上型肛瘘的临床疗效对比观察

Comparison of clinical effectiveness of diverting seton and cutting seton for su⁃pra-sphincteric fistula

目的对比改道挂线术与切开挂线术治疗括约肌上型肛瘘的临床疗效。方法回顾性分析2017年6月至2022年6月安溪县医院肛肠外科收治的40例括约肌上型肛瘘患者的临床资料,按照手术方式的不同,分为观察组(采用改道挂线术治疗,n=20)和对照组(采用切开挂线术治疗,n=20)。记录、比较两组临床疗效(包括总体治疗有效与复发情况,前者包括治愈、显效、有效),术后恢复情况,术后疼痛程度,以及术后肛门功能。结果术后随访6~24个月,观察组术后治愈16例、显效0例、有效3例,复发1例;对照组术后治愈15例、显效0例、有效3例,复发2例。观察组的术后住院时间及创面愈合时间均短于对照组,观察组术后第7、第14天的VAS疼痛评分均低于对照组,差异有统计学意义(均P<0.05)。观察组术后3个月的Wexner肛门失禁评分低于对照组,差异有统计学意义(P<0.05),两组对成形便的控制功能均正常。结论改道挂线术与切开挂线术治疗括约肌上型肛瘘的临床疗效相近,改道挂线术对患者术后肛门功能的影响较小,且患者术后恢复较快。

Objectives To compare the clinical effectiveness of diverting seton and cutting seton for supra-sphincteric fistula.Methods A retrospective study was performed on 40 patients with supra-sphincteric fistula treated at the Department of Anorec⁃tal Surgery,Anxi County Hospital,between June 2017 and June 2022.Based on the surgical procedure,patients were divided in⁃to the observation group(receiving diverting seton,n=20)and the control group(receiving cutting seton,n=20).Clinical effective⁃ness(including overall treatment effectiveness and recurrence),postoperative recovery,postoperative pain level,and postoperative anal function were recorded and compared between the two groups.Results During the 6-24 month follow-up,there were 16 cured cases,no remarkably effective cases,3 effective cases,and 1 recurrence in the observation group.In the control group,there were 15 cured cases,no remarkably effective cases,3 effective cases,and 2 recurrences.Postoperative hospitalization time and time to wound healing were shorter,and pain scores according to the Visual Analogue Scale at 7 and 14 days after surgery were lower in the observation group(P<0.05).The Wexner anal incontinence score was lower in the observation group at 3 months after surgery(P<0.05),and the control function of formed stool was normal in both groups.Conclusion In conclusion,the clinical effectiveness of diverting seton and cutting seton for supra-sphincteric fistula were comparable.Patients who received diverting seton treatment experienced less impact on postoperative anal function and achieved satisfactory recovery.