肛瘘切开肌层缝合内口引流术对低位肛瘘患者创面恢复、肛门功能及肛管高压带长度的影响

Effects of anal fistula incision,muscle layer suture and internal drainage surgery on wound recovery,anal function and anal high pressure zone length in patients with low anal fistula

目的观察肛瘘切开肌层缝合内口引流术治疗低位肛瘘的临床效果。方法回顾性选择2021年3月至2023年3月张家口市第五医院收治的65例低位肛瘘患者,依据手术方式的不同分为对照组和研究组,对照组32例采用传统肛瘘切开挂线引流术,研究组33例采用肛瘘切开肌层缝合内口引流术。比较手术用时、创面恢复情况、肛门功能、肛肠动力学、疼痛程度、复发率。结果研究组手术用时较对照组长[(34.86±4.17)min比(25.21±3.95)min],创面愈合时间较对照组短[(15.72±3.26)d比(18.94±4.42)d],创面面积较对照组小[(5.76±1.72)cm^(2)比(7.78±1.89)cm^(2)],差异有统计学意义(P<0.05)。术后4周,两组Wexner评分低于术后1 d(P<0.05),且研究组低于对照组[(3.39±1.08)分比(4.15±1.21)分],差异有统计学意义(P<0.05)。术后对照组肛管高压带长度、肛管静息压、肛管最大收缩压低于术前(P<0.05),且研究组高于对照组[(4.92±1.11)cm比(3.64±1.02)cm、(11.93±1.22)kPa比(9.45±1.08)kPa、(13.34±3.42)kPa比(10.82±2.75)kPa],差异有统计学意义(P<0.05)。术后48 h,两组视觉模拟评分法评分低于术后12 h(P<0.05),且研究组低于对照组[(1.63±0.21)分比(2.25±0.34)分],差异有统计学意义(P<0.05)。随访半年两组均未见复发。结论肛瘘切开肌层缝合内口引流术治疗低位肛瘘可缩短创面愈合时间,缩小创面面积,改善肛门功能、肛肠动力学,减轻疼痛,避免复发,但手术用时较长。

ObjectiveTo observe the clinical effect of anal fistula incision,muscle layer suture,and internal drainage surgery in the treatment of low anal fistula.MethodsA retrospective study was conducted on 65 patients with low anal fistula admitted to Fifth Hospital of Zhangjiakou City From March 2021 to March 2023,and they were divided into two groups based on different surgical methods.The control group consisted of 32 patients who underwent traditional anal fistula incision and thread drainage,while the study group consisted of 33 patients who underwent anal fistula incision and muscle layer suture internal drainage.The duration of surgery,wound recovery,anal function,anal motility,degree of pain,and recurrence rate were compared.ResultsThe surgical time of the study group was longer than that of the control group:(34.86±4.17)min vs.(25.21±3.95)min(P<0.05),the wound healing time was shorter than that of the control group:(15.72±3.26)d vs.(18.94±4.42)d(P<0.05),and the wound area was smaller than that of the control group:(5.76±1.72)cm 2 vs.(7.78±1.89)cm 2(P<0.05).At 4 weeks after surgery,the Wexner scores in both groups were lower than those at 1 d after surgery(P<0.05),and the study group was lower than the control group:(3.39±1.08)scores vs.(4.15±1.21)scores(P<0.05).After surgery,the high pressure zone length,anal rest pressure and anal maximum contraction pressure in the control group were lower than before surgery(P<0.05),and the study group were higher than the control group:(4.92±1.11)cm vs.(3.64±1.02)cm,(11.93±1.22)kPa vs.(9.45±1.08)kPa,(13.34±3.42)kPa vs.(10.82±2.75)kPa(P<0.05).At 48 h after surgery,the visual analogue scale(VAS)scores of both groups were lower than those at 12 h after surgery(P<0.05),and the study group was lower than the control group:(1.63±0.21)scores vs.(2.25±0.34)scores(P<0.05).After 6 months of follow-up,neither group experienced any recurrence.ConclusionsAnal fistula incision,muscle layer suture and internal drainage surgery for low anal fistula can shorten the wound healing time,reduce the wound area,improve anal function and anal motility,alleviate pain,and avoid recurrence.However,the surgical time is longer.