肛门外括约肌裸化术与Hanley术治疗高位马蹄形肛瘘的临床疗效对比观察

Comparison of clinical efficacy between external anal sphincter bareness and the Hanley procedure for high horseshoe anal fistula

目的 对比分析肛门外括约肌裸化术与Hanley术治疗高位马蹄形肛瘘的临床疗效。方法 纳入2019年3月至2021年3月于上海中医药大学附属曙光医院肛肠科住院治疗的104例高位马蹄形肛瘘患者为研究对象,按照手术方式的不同,将患者分为治疗组(n=49,采用肛门外括约肌裸化术)和对照组(n=55,采用Hanley术)。比较两组的愈合率、复发率,术中情况(手术时间、术中出血量),创面愈合时间,术后并发症(术后疼痛、创面出血、创面感染),以及手术前后的肛门功能。结果 两组愈合率及复发率比较差异无统计学意义(P> 0.05)。治疗组手术时间短于对照组,术中出血量少于对照组,创面愈合时间较对照组提前,差异有统计学意义(P <0.05)。治疗组术后第7、第14天的VAS疼痛评分低于对照组,差异有统计学意义(P <0.05);两组均未出现创面出血、创面感染。两组术前及术后3个月的Wexner肛门失禁评分比较差异无统计学意义(P> 0.05)。结论 肛门外括约肌裸化术是治疗高位马蹄形肛瘘的有效术式,在减少术中出血量、减轻术后疼痛及缩短创面愈合时间方面相比Hanley术有优势。

Objectives To compare and analyze the clinical efficacy of external anal sphincter bareness and the Hanley proce-dure in treating high horseshoe anal fistula.Methods A total of 104 patients with high horseshoe anal fistula who were hospital-ized in the Department of Anorectal Diseases,Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medi-cine from March 2019 to March 2021 were included.Patients were divided into two groups based on different surgical methods:the treatment group(n=49)received external anal sphincter bareness,while the control group(n=55)underwent the Hanley pro-cedure.The healing rate,recurrence rate,intraoperative conditions(operation time,intraoperative blood loss),wound healing time,postoperative complications(postoperative pain,wound bleeding,wound infection),and preoperative and postoperative anal function were compared between the two groups.Results There were no significant differences in healing rate and recurrence rate be-tween the two groups(P>0.05).However,the treatment group exhibited a statistically significant advantage with a shorter opera-tion time,reduced intraoperative blood loss,and earlier wound healing time compared to the control group(P<0.05).The Visual Analogue Scale pain scores on postoperative day 7 and day 14 were significantly lower in the treatment group than in the con-trol group(P<0.05).Both groups experienced no wound bleeding or infection.Additionally,there was no significant difference in Wexner incontinence scores between the two groups before surgery and at 3 months after surgery(P>0.05).Conclusion The ex-ternal anal sphincter bareness proves to be an effective surgical method for the treatment of high horseshoe anal fistula.In com-parison to the Hanley procedure,it demonstrates advantages in reducing intraoperative blood loss,alleviating postoperative pain,and shortening wound healing time.