经肛括约肌间切开术联合改良Hanley术治疗高位经括约肌肛瘘的临床疗效

Clinical effect of transanal intersphincterotomy combined with modified Hanley surgery in the treatment of high transsphincter anal fistula

目的对高位经括约肌肛瘘患者给予经肛括约肌间切开术(TROPIS)联合改良Hanley术治疗,探讨临床疗效。方法选取医院2020年1月至2023年1月收治的高位经括约肌肛瘘患者66例,根据治疗方式不同将其分为观察组33例与对照组33例,观察组实施TROPIS联合改良Hanley术治疗;对照组实施传统切开挂线术治疗。对两组临床治疗效果、术后疼痛、创面愈合、肛门功能、肛管直肠压力情况、手术前后患者生活质量及术后并发症、复发率进行统计比较。结果观察组治疗总有效率100.0%与对照组治疗总有效率84.8%比较显著提高(P<0.05);与对照组比较,观察组术后48 h伤口VAS评分显著降低,创面愈合时间显著缩短,肛门括约肌评分显著降低(P<0.05);两组术前Wexner肛门失禁评分比较差异无显著性,术后两组评分均较术前显著降低,其中观察组降低程度显著优于对照组(P<0.05);在肛管压力方面,两组术前比较均无显著性,术后1个月,两组肛管静息压、肠管静息压及最大收缩压均显著降低,其中与对照组比较,观察组术后压力显著提高(P<0.05);两组术前SF-36量表总分比较差异无显著性,术后1个月、6个月,两组总分均较术前显著提高,其中观察组总分提高程度显著优于对照组(P<0.05);与对照组比较,观察组术后并发症发生率显著降低(P<0.05)。结论对高位经括约肌肛瘘患者实施TROPIS联合改良Hanley术治疗能够取得良好的临床疗效,可减轻术后疼痛,显著改善患者肛门功能及生活质量,降低术后并发症发生,值得进一步推广应用。

Objective To investigate the clinical effect of transanal intersphincterotomy(TROPIS)combined with modified Hanley for the treatment of patients with high transsphincter anal fistula.Methods 66 patients with high transsphincter anal fistula admitted to our hospital from January 2020 to January 2023 were selected and divided into observation group(n=33)and control group(n=33)according to different treatment methods.TROPIS combined with improved Hanley was applied to the observation group.Traditional incision and hanging suture was applied to the control group.Clinical treatment effect,postoperative pain,wound healing,anal function,anorectal pressure,quality of life of patients before and after surgery,postoperative complications and recurrence rate were statistically compared between the two groups.Results The total effective rate of the observation group was 100.0%and that of the control group was 84.8%(P<0.05).Compared with the control group,the wound VAS score 48 h after surgery in the observation group was significantly decreased,the wound healing time was significantly shortened,and the anal sphincter score was significantly decreased,with statistical significance(P<0.05).There was no significant difference in Wexner anal incontinence score between the two groups before surgery,and the score of the two groups after surgery was significantly reduced,and the reduction degree of the observation group was significantly better than that of the control group(P<0.05).In terms of anal canal pressure,there was no significant difference between the two groups before surgery.One month after surgery,the anal canal resting pressure,intestinal canal resting pressure and maximum systolic pressure of the two groups were significantly decreased,and the postoperative pressure of the observation group was significantly increased compared with the control group(P<0.05).There was no significant difference in the total score of SF-36 scale between the two groups before surgery,but the total score of the two groups was significantly increased 1 month and 6 months after surgery,and the improvement degree of the total score of the observation group was significantly better than that of the control group(P<0.05).The incidence of postoperative complications in the observation group was significantly decreased compared with the control group(P<0.05).Conclusion The application of TROPIS combined with modified Hanley in the treatment of patients with high transsphincter anal fistula can achieve good clinical efficacy,reduce postoperative pain,significantly improve patients'anal function and quality of life,and reduce postoperative complications,which is worthy of further promotion and application.