经括约肌间切开虚挂线术治疗高位复杂性肛瘘的临床研究

Clinical study on transanal intersphincterotomy and loose seton therapy in the treatment of high complex anal fistulas

目的:评价经括约肌间切开虚挂线术治疗高位复杂性肛瘘的疗效与安全性。方法:选取符合高位复杂性肛瘘诊断的80例患者,随机分为两组,每组40例。治疗组采用经括约肌间切开虚挂线术,对照组使用高位肛瘘挂线术。通过观察术后第1、7、14天肛门局部症状及创面愈合时间,评估术后肛门功能及临床疗效。结果:治疗组有效率明显高于对照组(P<0.05);与对照组相比,治疗组术后第1、7天出血、疼痛及肛门坠胀感明显较轻,术后第7、14天渗液明显较少;治疗组术后3、6个月Wexner肛门失禁评分均明显低于对照组,差异均有统计学意义(P<0.05);术后3、6个月随访治疗组最长收缩时间(ALCT)和肛管最大收缩压(AMCP)均明显高于对照组(P<0.05)。结论:经括约肌间切开虚挂线术治疗高位复杂性肛瘘疗效显著,术后并发症少,能较好地维护术后肛门功能。

Objective:To evaluate the efficacy and safety of transsphincteric fistulotomy combined with seton placement for the management of high complex anal fistulas.Methods:80 patients diagnosed with high complex anal fistulas were randomly divided into two groups,with 40 patients in each group.The treatment group underwent transsphincteric fistulotomy combined with seton placement,while the control group received high ligation of anal fistula tract.The postoperative anal function and clinical efficacy were evaluated by observing local anal symptoms and wound healing time on the 1st,7th,and 14th day after surgery.Results:The effective rate in the treatment group was significantly higher than that in the control group(P<0.05).Compared with the control group,the treatment group showed significantly less bleeding,pain,and sense of anal prolapse on the 1st and 7th day after sugery,and significantly less exudation on the 7th and 14th day after sugery.The Wexner incontinence scores of the treatment group at 3 and 6 months after sugery were significantly lower than those of the control group,indicating statistically significant differences(P<0.05).Furthermore,the anal longest contraction(ALCT)and the anal maximal contraction pressure(AMCP)of the treatment group were significantly higher than those of the control group at the 3 and 6-month postoperative follow-up(P<0.05).Conclusion:Transsphincteric fistulotomy combined with seton placement exhibits remarkable efficacy in the treatment of high complex anal fistulas,resulting in fewer postoperative complications and improved preservation of postoperative anal function.