切开挂线选择性缝合术治疗高位复杂性肛瘘的效果及对肛门功能和并发症的影响

Effect of incision and thread-drawing selective suture in the treatment of high complex anal fistula and its influence on anal function and complications

目的探讨切开挂线选择性缝合术在高位复杂性肛瘘患者人群中的治疗效果及其对肛门功能和并发症的影响。方法前瞻性选择2018年12月—2021年12月在宜宾市第二人民医院肛肠外科住院治疗的高位复杂性肛瘘患者174例作为研究对象,其中男性138例,女性36例,年龄26~45岁,平均年龄(35.20±8.86)岁。依据患者的入院顺序单号、双号进行分组,其中单号为对照组(n=87),双号为观察组(n=87)。对照组使用传统的切开挂线治疗,观察组采用切开挂线选择性缝合的治疗。对比2组患者的手术时间、失血量、手术费用、创面愈合时间长度、术后6个月的肛门功能情况和治疗效果,以及术后6个月内的并发症情况、术后1年内的复发情况。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用独立样本t检验,计数资料以例(%)表示,组间比较采用χ^(2)检验。等级资料对比采用秩和检验。结果观察组的手术时间长于对照组[(44.30±8.11)min比(42.18±7.25)min,t=-2.44,P<0.05]、手术费用高于对照组[(1184.81±372.68)元比(835.28±320.03)元,t=-8.75,P<0.001]。2组的失血量对比差异无统计学意义[(19.57±6.07)mL比(18.35±5.25)mL,t=-1.88,P>0.05]。观察组的创面愈合时间长度低于对照组[(24.18±4.35)d比(29.35±5.08)d,t=11.09,P<0.001]。观察组术后6个月的肛门功能评分低于对照组[(4.80±1.21)分比(6.71±1.35)分,t=14.72,P<0.001]。全部患者未发生失访,术后6个月的治疗效果对比中,观察组的疗效评级优于对照组(z=3.86,P<0.001)。术后6个月,观察组的并发症发生率低于对照组[2.30%(2/87)比10.34%(9/87),χ^(2)=4.76,P<0.05]。术后1年,,观察组的复发率低于对照组[2.30%(2/87)比10.34%(9/87),χ^(2)=4.76,P<0.05]。结论将切开挂线选择性缝合术应用到高位复杂性肛瘘患者的治疗过程中有利于患者的治疗效果,降低术后并发症,保护患者的肛门功能,具有良好的使用价值。

Objective To investigate the therapeutic effect of open suture and selective suture in patients with high complexity anal fistula and its effect on anal function and complications.Methods Prospectively selected 174 patients with high complex anal fistula who were hospitalized in the Anorectal Surgery Department of the Second People′s Hospital of Yibin City from December 2018 to December 2021 as the study subjects,including 138 males and 36 females,aged from 26 to 45 years,with an average of(35.20±8.86)years.According to the admission order of patients,grouped them into single and double numbers,with single numbers being the control group(n=87)and double numbers being the observation group(n=87).The control group was treated with traditional incision and thread hanging therapy,while the observation group was treated with selective suture through incision and thread hanging therapy.Compared the surgical time,blood loss,surgical cost,wound healing time,and anal function at 6 months after surgery between the two groups of patients.Compared the treatment effects of two groups of patients at 6 months after surgery.Compared the postoperative complications within 6 months and recurrence within 1 year between the two groups.The measurement data subject to normal distribution were expressed by mean±standard deviation(±s).The two groups were compared by independent sample t test,and the count data were compared by Chi-square test.Rank sum test was used for comparison of hierarchical data.Results The surgical time in the observation group was higher than that in the control group[(44.30±8.11)min vs(42.18±7.25)min,(t=-2.44),P<0.05],and the surgical cost was higher than that in the control group[(1184.81±372.68)yuan vs(835.28±320.03)yuan,t=-8.75,P<0.001].There was no statistically significant difference in blood loss data between the two groups[(19.57±6.07)mL vs(18.35±5.25)mL,t=-1.88,P>0.05].The length of wound healing time in the observation group was lower than that in the control group[(24.18±4.35)d vs(29.35±5.08)d,t=11.09,P<0.001].The anal function score of the observation group at 6 months after surgery was lower than that of the control group[(4.80±1.21)score vs(6.71±1.35)score,t=14.72,P<0.001].All patients did not experience any loss of follow-up.In the comparison of treatment effects 6 months after surgery,the observation group had a better efficacy rating than control group(Z=3.86,P<0.001).At 6 months after surgery,the incidence of complications in the observation group was lower than that in the control group[2.30%(2/87)vs 10.34%(9/87),χ^(2)=4.76,P<0.05].One year after surgery,the recurrence rate in the observation group was lower than that in the control group[2.30%(2/87)vs 10.34%(9/87),χ^(2)=4.76,P<0.05].Conclusion The application of incision and thread-drawing selective suture in the treatment of patients with high complex anal fistula is beneficial to the treatment effect of patients,reduces postoperative complications,and protects the anal function of patients,with good use value.