高位肛瘘分次虚实高挂术治疗高位肛瘘临床疗效研究

Study on the Clinical Effect of High Anal Fistula Treated by Multiple Sthenosteric Hypersuspension

目的评价高位肛瘘分次虚实高挂术治疗高位肛瘘的临床疗效。方法两组患者采用随机单盲设计,试验组给予高位肛瘘分次虚实高挂术,对照组给予经典高位肛瘘挂线术,术前对两组患者肛管直肠测压作为基线资料对比。主要评价指标为临床疗效、术后疼痛评分、Wexner肛门失禁评分、创面愈合时间、肛管直肠测压、肛门括约肌维度变化;次要评价指标为挂线脱落时间、术后出血、尿潴留、排便情况及创面感染情况。结果①临床疗效及脱线时间:试验组治愈30例(75%),好转10例(25%),无效0例;对照组治愈30例(71.4%),好转12例(28.6%),无效0例,P=0.717,两组差异无统计学意义;试验组皮筋脱落时间为(12.5±3.58)d,对照组为(9.55±3.13)d,P<0.05;试验组患者痊愈时间(37.3±7.67)d,对照组痊愈时间(41.52±8.52)d,两组差异有统计学意义(P<0.05),试验组优于对照组。②安全性评价:两组肛管直肠测压比较,肛管静息压、肛管最大收缩压、肛管最长收缩时间、肛管舒张压、咳嗽反射肛管收缩压手术前后对比,差异有统计学意义(P<0.05),直肠静息压及肛管长度手术前后对比差异无统计学意义(P>0.05);试验组与对照组术后肛管静息压、咳嗽反射肛管收缩压改变比较,差异有统计学意义(P<0.05),试验组优于对照组,直肠静息压、肛管长度、肛管最大收缩压、肛管最长收缩时间、肛管舒张压改变比较,差异无统计学意义(P>0.05)。③术后症状:两组患者术后出血、尿潴留发生率比较差异无统计学意义(P>0.05);术后第1、7天试验组疼痛评分(VAS)优于对照组,差异有统计学意义(P<0.05),第3、14天两组VAS评分比较差异无统计学意义(P>0.05)。排便情况术后第3、7天两组比较差异有统计学意义(P<0.05),试验组优于对照组。肛门坠胀情况术后第30天两组比较差异有统计学意义(P<0.05),试验组优于对照组。结论该研究验证了基于括约肌功能保护的高位肛瘘分次虚实高挂术治疗高位肛瘘安全性优于高位肛瘘一次性挂线术,术后疼痛、排便等情况发生率低于高位肛瘘一次性挂线术。两组远期疗效及治愈率无明显差异。

Objective To evaluate the clinical efficacy of high anal fistula treated by multiple sthenosteric hypersuspension in the treatment of high anal fistula. Methods Two groups of patients were designed randomly and single blindly. The test group was treated with high anal fistula treated by multiple sthenosteric hypersuspension and the control group was treated with classical high anal fistula. The anorectal pressure of the two groups was measured before operation,and the baseline data were compared. The main evaluation indicators were clinical efficacy,postoperative pain score,Wexner anal incontinence score,wound healing time,anorectal manometry,anal sphincter dimension changes. The secondary evaluation indexes were shedding time,postoperative bleeding,urinary retention,defecation and wound infection.Results ① The clinical efficacy and off-line time were cured in 30 cases(75%),improved in 10 cases(25%)and ineffective in 0 case in the experimental group,while those in the control group were cured in 30 cases(71.4%),improved in 12 cases(28.6%)and ineffective in 0 case,P =0.717. There was no significant difference between the two groups. The shedding time of skin tendons was(12.5± 3.58)days in the experimental group and(9.55±3.13)days in the control group(P <0.05). The recovery time was(37.3±7.67)days in the experimental group and(41.52±8.52)days in the control group. There was significant difference between the two groups,and the experimental group was better than the control group. ② Safety evaluation:The comparison of anorectal manometry before and after operation between the two groups showed that anal resting pressure,maximum systolic pressure,longest systolic time,anal diastolic pressure and cough reflex anal systolic pressure were significantly different before and after operation(P <0.05). There was no significant difference in rectal resting pressure and anal length before and after operation. There was significant difference in anal resting pressure and cough reflex anal systolic pressure between the experimental group and the control group(P <0.05). There was no significant difference in rectal resting pressure,anal length,maximum systolic blood pressure, longest contraction time and anal diastolic pressure(P >0.05). ③ Postoperative symptoms:There was no significant difference in the incidence of postoperative bleeding and urinary retention between the two groups. The VAS score of postoperative pain in the test group was lower than that in the control group on the first and 7th day after operation,and the difference was statistically significant. There was no statistically significant difference in VAS scores between the two groups on the 3rd and 14th day. There was significant difference in defecation on the 3rd and 7th day after operation,and the experimental group was better than the control group. There was significant difference in anal distension on the 30th day after operation between the experimental group and the control group(P <0.05),and the experimental group was better than the control group. Conclusion This study verified that the safety of high anal fistula treated by multiple sthenosteric hypersuspension based on the protection of sphincter function for the treatment of high anal fistula was better than that of the one-time thread hanging surgery for high anal fistula. The incidence of postoperative pain,fluid leakage,and defecation were lower than that of one-time thread hanging surgery for high anal fistula. There was no significant difference in long-term efficacy and cure rate between the two groups.