切开扩创引流合并挂线法治疗高位复杂性肛瘘患者的临床效果

Clinical effect of incision debridement and drainage combined with thread-ligating therapy in the treatment of patients with high anal fistulae

目的针对高位复杂性肛瘘(HAF)患者行切开扩创引流合并挂线法治疗,观察其临床疗效及对患者肛肠功能的影响。方法66例HAF患者,依据随机数字表法分为对照组与观察组,每组33例。对照组患者行单纯切开挂线法治疗,观察组患者在对照组基础上联合切开扩创引流治疗。比较两组术后恢复指标、肛肠动力学指标、疗效及并发症发生情况。结果观察组患者创面愈合时间(21.45±2.36)d、住院时间(16.42±1.45)d均较对照组的(27.16±2.42)、(22.61±1.61)d短,瘢痕面积(3.53±0.22)cm^(2)较对照组的(5.16±0.35)cm^(2)更小(P<0.05)。术后1周,观察组肛管静息压、直肠静息压、肛管最大收缩压与术前比较差异不明显(P>0.05);对照组肛管静息压、直肠静息压、肛管最大收缩压较术前降低明显(P<0.05);观察组术后1周肛管静息压、直肠静息压、肛管最大收缩压高于对照组(P<0.05)。观察组总有效率90.91%较对照组的69.70%更高(P<0.05)。观察组并发症发生率6.06%较对照组的24.24%更低(P<0.05)。结论HAF患者在切开挂线法基础上联合切开扩创引流治疗,有利于缓解疼痛、促进术后恢复,对肠道功能具有一定的保护作用,并发症少,疗效可靠。

Objective To observe the clinical efficacy of incision debridement and drainage combined with thread-ligating therapy in the treatment of patients with high anal fistulae(HAF),and its influence of anorectal function of the patients.Methods 66 HAF patients were divided into a control group and an observation group according to random number table method,with 33 cases in each group.The control group was treated with incision and thread-ligating therapy,and the observation group was treated with incision debridement and drainage on the basis of the control group.The postoperative recovery indexes,anorectal dynamics indexes,efficacy and complications were compared between the two groups.Results The wound healing time and hospitalization time of the observation group were(21.45±2.36)d and(16.42±1.45)d,which were shorter than(27.16±2.42)d and(22.61±1.61)d of the control group;the observation group had smaller scar area of(3.53±0.22)cm^(2) than(5.16±0.35)cm^(2) of the control group(P<0.05).In the observation group,the anal canal resting pressure,rectal canal resting pressure and maximum anal systolic pressure 1 week after operation were not significantly different from those before operation(P>0.05).In the control group,the anal canal resting pressure,rectal canal resting pressure and maximum anal systolic pressure 1 week after operation were obviously lower than those before operation(P<0.05).The anal canal resting pressure,rectal canal resting pressure and maximum anal systolic pressure 1 week after operation in the observation group were higher than those in the control group(P<0.05).The observation group had total effective rate of 90.91%,which was higher than 69.70%in the control group(P<0.05).The observation group had complication rate of 6.06%,which was lower than 24.24%in the control group(P<0.05).Conclusion For HAF patients,the combination of incision debridement and drainage on the basis of threadligating therapy is conducive to relieve pain,promote postoperative recovery,and has a certain protective effect on intestinal function,with fewer complications and reliable efficacy.