经肛括约肌间切开术治疗肛瘘的疗效观察

Clinical Efficacy of Transanal Sphincter Interposition Incision on Anal Fistula

目的:探讨经肛括约肌间切开术治疗肛瘘的临床疗效。方法:本研究选择2019年6月至2023年1月75例肛周脓肿患者,根据患者意愿进行分组,对照组35例患者采用传统肛瘘切开挂线术,观察组40例患者采用经肛括约肌间切开术,比较2组患者的疗效、手术相关指标、术后1 d、3 d、7 d疼痛评分、手术前后Wexner肛门失禁评分以及肛管静息压(ARP)、肛管最大收缩压(AMCP)。结果:观察组患者总有效率高于对照组(P<0.05)。2组患者术中出血量比较差异无统计学意义(P>0.05),观察组患者住院时间、创面愈合时间均短于对照组(P<0.05)。2组患者术后1 d疼痛评分比较差异无统计学意义(P>0.05),术后3 d、7 d观察组明显低于对照组(P<0.05)。术前2组患者Wexner评分、ARP、AMCP比较差异无统计学意义(P>0.05);术后3个月2组患者Wexner评分均高于术前,ARP、AMCP评分低于术前,但观察组术后3个月Wexner评分明显低于对照组,ARP、AMCP明显高于对照组,比较差异有统计学意义(P<0.05)。结论:经肛括约肌间切开术治疗肛瘘较传统肛瘘切开挂线术住院时间短,创面愈合快,术后疼痛轻,能更好地保护肛门功能。

Objective To investigate the clinical efficacy of transanal sphincter interposition incision(TROPIS)in the treatment of anal fistula.Methods In this study,a total of 75 patients with perianal abscess from June 2019 to January 2023 were selected and divided into groups according to the patients'will.Total 35 patients in the control group received traditional incision thread-drawing surgery,and 40 pa-tients in the observation group were given TROPIS.The clinical efficacy,surgical related indexes,pain scores on the 1st,3rd and 7th day after operation,Wexner anal incontinence scores before and after opera-tion,anal resting pressure(ARP)and anal maximal contraction pressure(AMCP)were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The length of hospital stay and wound healing time in the observation group were shorter than those in the control group(P<0.05).There was no significant difference between the two groups in pain scores on the 1st day after operations(P>0.05),which was significantly lower in the observation group than in the control group on the 3rd and 7th day after operation(P<0.05).There was no significant difference in Wexner scores,ARP and AMCP between the two groups before operation(P>0.05).Three months after operation,Wexner scores in both groups were higher than before operation,and ARP and AMCP scores were lower than before operation,but Wexner scores in the observation group were significantly lower than those in the control group,and ARP and AMCP scores were significantly higher than those in the control group,with statistical significance(P<0.05).Conclusion TROPIS for the treatment of anal fistula has shorter hospital stay,faster wound healing,less postoperative pain,and better protection of anal function than traditional incision thread-drawing surgery.