Ligation of intersphincteric fistula tract and its modification: Results from treatment of complex fistula

AIM: To compare healing rates between intersphincteric fistula tract (LIFT) and LIFT plus partial fistulectomy procedures. METHODS: A study of complex fistula-in-ano patients was carried out from 1 st March 2010 to 31 th January 2012. All operations were done by colorectal surgeons at a referral center in a Ministry of Public Health hospital. Data collected included patients' demographic details, fistula type determined by endorectal-ultraso-nography, preoperative and postoperative continence status, previous operations, time between diagnosis of fistula-in-ano and operation, type of surgery, healing rates, recurrence rates, and types of failure examined by endorectal-ultrasosnography, re-operation in recurrence or failure cases, and complications. RESULTS: The study involved 41 patients whose average age was 40.78 ± 11.84 years (range: 21-71 years). The major fistula type was high-transsphincteric type fistula. The median follow-up period was 24 wk. The overall success rate was 83%: in the LIFT (Ligation intersphincteric fistula tract) group the success rate was 81% and in the LIFT plus (LIFT with partial coreout fistulectomy) group it was 85% (P = 0.529). The median wound-healing time was 4 wk in both groups (P = 0.262). The median time to recurrence was 12 wk. Neither group had incontinence (Wexner incontinence score-0) and the difference in healing rates between the two groups was not statistically significant. CONCLUSION: There was no difference in results between LIFT and LIFT plus operations. The LIFT procedure is a good option for maintaining continence in management of fistula-in-ano.

Anal fistula plugvs mucosa advancement flap in complex fistula-in-ano:A meta-analysis

AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included PubMed,EMBASE,Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011.Randomized controlled trials,controlled clinical trials and prospective cohort studies were included in the review.After information collection,a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity.The quality of postoperative life was also included with the clinical results.RESULTS:Six studies involving 408 patients(AFP = 167,MAF = 241) were included in the meta-analysis.The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference(RD) =-0.12,95%CI:-0.39-0.14;RD = 0.13;95%CI:-0.18-0.43,respectively].However,for the AFP,the risk of postoperative impaired continence was lower(RD =-0.08,95%CI:-0.15--0.02) as was the incidence of other complications(RD =-0.06,95%CI:-0.11-0.00).The postoperative quality of life,for patients treated using the AFP was superior to that of the MAF patients.Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced.CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula;it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life.Additional evidence is needed to confirm these findings.

High complex anal fistula managed by the modified transanal opening of the intersphincteric space via the inter-sphincteric approach:A case report

BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring.Postoperative loss of anal function can cause physical and mental damage.Transanal opening of the intersphincteric space(TROPIS)is an effective procedure that completely preserves the external anal sphincter.However,its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications.On the basis of our clinical experience,we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.CASE SUMMARY A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS,which involved sepsis drainage and identification of the internal opening in the intersphincteric space.The patient with the high complex anal fistula recovered well postoperatively,without any postoperative complications or anal dysfunction.Anal function returned to normal after 17 months of follow-up.CONCLUSION The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function.It allows the complete removal of infected anal glands and reduces the risk of postoperative complications.Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.

Up-to-date meta-analysis of long-term evaluations of mesenchymal stem cell therapy for complex perianal fistula

BACKGROUND Local mesenchymal stem cell(MSC)therapy for complex perianal fistulas(PFs)has shown considerable promise.But,the long-term safety and efficacy of MSC therapy in complex PFs remain unknown.AIM To explore the long-term effectiveness and safety of local MSC therapy for complex PFs.METHODS Sources included the PubMed,EMBASE,and Cochrane Library databases.A standard meta-analysis was performed using RevMan 5.3.RESULTS After screening,6 studies met the inclusion criteria.MSC therapy was associated with an improved long-term healing rate(HR)compared with the control condition[odds ratio(OR)=2.13;95%confidence interval(95%CI):1.34 to 3.38;P=0.001].Compared with fibrin glue(FG)therapy alone,MSC plus FG therapy was associated with an improved long-term HR(OR=2.30;95%CI:1.21 to 4.36;P=0.01).When magnetic resonance imaging was used to evaluate fistula healing,MSC therapy was found to achieve a higher long-term HR than the control treatment(OR=2.79;95%CI:1.37 to 5.67;P=0.005).There were no significant differences in long-term safety(OR=0.77;95%CI:0.27 to 2.24;P=0.64).CONCLUSION Our study indicated that local MSC therapy promotes long-term and sustained healing of complex PFs and that this method is safe.

Randomized controlled trial of minimally invasive surgery using acellular dermal matrix for complex anorectal fistula

AIM: To compare the efficacy and safety of acellular dermal matrix (ADM) bioprosthetic material and endorectal advancement flap (ERAF) in treatment of complex anorectal fistula. METHODS: Ninety consecutive patients with complex anorectal fistulae admitted to Anorectal Surgical Department of First Affi liated Hospital, Xinjiang Medical University from March 2008 to July 2009, were enrolled in this study. Complex anorectal fistula was diagnosed following its clinical, radiographic, or endoscopic diagnostic criteria. Under spinal anesthesia, patients underwent identification and irrigation of the fistula tracts using hydrogen peroxide. ADM was securely sutured at the secondary opening to the primary opening using absorbable suture. Outcomes of ADM and ERAF closure werecompared in terms of success rate, fecal incontinence rate, anorectal deformity rate, postoperative pain time, closure time and life quality score. Success was defined as closure of all external openings, absence of drainage without further intervention, and absence of abscess formation. Follow-up examination was performed 2 d, 2, 4, 6, 12 wk, and 5 mo after surgery, respectively. RESULTS: No patient was lost to follow-up. The overall success rate was 82.22% (37/45) 5.7 mo after surgery. ADM dislodgement occured in 5 patients (11.11%), abscess formation was found in 1 patient, and fistula recurred in 2 patients. Of the 13 patients with recurrent fistula using ERAF, 5 (11.11%) received surgical drainage because of abscess formation. The success rate, postoperative pain time and closure time of ADM were significantly higher than those of ERAF (P < 0.05). However, no difference was observed in fecal incontinence rate and anorectal deformity rate after treatment with ADM and ERAF. CONCLUSION: Closure of fistula tract opening with ADM is an effective procedure for complex anorectal fistula. ADM should be considered a first line treatment for patients with complex anorectal fistula.

Stem cell injection for complex anal fistula in Crohn’s disease: A single-center experience

BACKGROUND Despite tremendous progress in medical therapy and optimization of surgical strategies,considerable failure rates after surgery for complex anal fistula in Crohn’s disease have been reported.Therefore,stem cell therapy for the treatment of complex perianal fistula can be an innovative option with potential long-term healing.AIM To evaluate the results of local administration of allogenic,adipose-derived mesenchymal stem cells(darvadstrocel)for complex anal Crohn’s fistula.METHODS All patients with complex anal fistulas associated with Crohn’s disease who were amenable for definite fistula closure within a defined observation period were potential candidates for stem cell injection(darvadstrocel)if at least one conventional or surgical attempt to close the fistula had failed.Darvadstrocel was only indicated in patients without active Crohn’s disease and without presence of anorectal abscess.Local injection of darvadstrocel was performed as a standardized procedure under general anesthesia including single-shot antibiotic prophylaxis,removal of seton drainage,fistula curettage,closure of the internal openings and local stem cell injection.Data collection focusing on healing rates,occurrence of abscess and follow-up was performed on a regular basis of quality control and patient care.Data were retrospectively analyzed.RESULTS Between July 2018 and January 2021,12 patients(6 females,6 males)with a mean age of 42.5(range:26-61)years underwent stem cell therapy.All patients had a minimum of one complex fistula,including patients with two complex fistulas in 58.3%(7/12).Two of the 12 patients had horse-shoe fistula and 3 had one complex fistula.According to Parks classification,the majority of fistulas were transsphincteric(76%)or suprasphincteric(14%).All patients underwent removal of seton,fistula curettage,transanal closure of internal opening by suture(11/12)or mucosal flap(1/12)and stem cell injection.At a mean follow-up of 14.3(range:3-30)mo,a healing rate was documented in 66.7%(8/12);mean duration to achieve healing was 12(range:6-30)wk.Within follow-up,4 patients required reoperation due to perianal abscess(33.3%).Focusing on patients with a minimum follow-up of 12 mo(6/12)or 24 mo(4/12),long-term healing rates were 66.7%(4/6)and 50.0%(2/4),respectively.CONCLUSION Data of this single-center experience are promising but limited due to the small number of patients and the retrospective analysis.

Burden and outcomes for complex perianal fistulas in Crohn's disease:Systematic review

AIM To systematically review the literature on epidemiology,disease burden, and treatment outcomes for Crohn's disease(CD) patients with complex perianal fistulas.METHODS PubMed, Embase, and Cochrane were searched for relevant articles(published 2000-November 2016) and congress abstracts(published 2011-November 2016).RESULTS Of 535 records reviewed, 62 relevant sources were identified(mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14%(follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment(failure and relapse rates,respectively: medical, 12%-73% and 0%-41%; surgical:0%-100% and 11%.20%; combined medical/surgical:0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies(1 of infliximab; 3 of surgical interventions)have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in CD.CONCLUSION Complex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to antitumour necrosis factor-α agents, as evidenced by high failure and relapse rates.

基于倾向性评分匹配法评估切开挂线对口引流术与传统切开挂线术治疗老年高位复杂性肛瘘的效果

目的基于倾向性评分匹配法评估切开挂线对口引流术(FSD)与传统切开挂线术(TSF)治疗老年高位复杂性肛瘘的效果。方法回顾性分析2020年3月至2023年3月北京市肛肠医院肛肠外科收治的220例患者的临床资料,其中FSD组117例,TSF组103例,采用1∶1倾向性评分匹配法筛选出82对匹配队列,比较两组患者术后疗效、恢复、疼痛程度、肛肠动力学、肛管功能及复发情况。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用logistic回归模型计算倾向性评分,近邻匹配法进行1∶1匹配。结果匹配后FSD组术后24 h视觉模拟评分法(VAS)评分低于TSF组[(4.21±1.18)和(5.04±1.36)分],临床总有效率高于TSF组[96.34%(79/82)和87.80%(72/82)],创面愈合时间短于TSF组[(12.34±2.45)和(14.67±2.89)d],差异均有统计学意义(P<0.05)。术后1个月,FSD组肛管功能长度、最大耐受量及初始感觉阈值均大于TSF组[(2.86±0.34)和(2.31±0.46)cm;(135.21±19.87)和(119.52±20.13)ml;(25.16±2.57)和(22.89±2.92)ml],差异均有统计学意义(P<0.05)。术后1个月,FSD组Wexner评分低于TSF组[(0.92±0.27)和(1.17±0.35)分];复发率低于TSF组[3.66%(3/82)和12.20%(10/82)],差异有统计学意义(P<0.05)。结论FSD治疗老年高位复杂性肛瘘疗效确切,术后创面愈合快、对肛管功能损伤小,且复发率低。

梅花针技术防治复杂性肛瘘术后早期并发症的临床疗效评价

目的 评价梅花针技术防治复杂性肛瘘术后早期并发症的临床疗效。方法 选取2022年3月至2023年2月在上海中医药大学附属曙光医院肛肠科行复杂性肛瘘手术的132例患者作为研究对象,按照随机数字表法将其分为观察组(梅花针技术加术后常规护理)和对照组(术后常规护理),每组各66例。比较2组患者术后早期并发症防治总有效率、术后疼痛程度、排尿困难发生率、住院满意度。结果 观察组总有效率高于对照组,尿潴留发生率低于对照组,治疗后30 min及治疗后2 h疼痛程度低于对照组,住院满意度高于对照组,差异均有统计学意义(P<0.05)。结论 复杂性肛瘘术后采用梅花针技术治疗可有效防治早期并发症,减轻疼痛,降低尿潴留发生率,患者住院满意度较高。

经肛门直肠黏膜瓣推移术与经肛括约肌间切开术治疗复杂性肛瘘的效果及对肛管直肠压力的影响

目的 探讨经肛门直肠黏膜瓣推移术(endoanal advancement flap,ERAF)与经肛括约肌间切开术(transanal opening of intersphincteric space,TROPIS)治疗复杂性肛瘘的效果及对肛管直肠压力的影响。方法 2018年10月~2022年10月收治的复杂性肛瘘病人84例,按治疗方法分为ERAF治疗组(E组,48例)和TROPIS治疗组(T组,36例)。比较两组临床疗效、手术情况、创面情况以及肛管直肠压力。结果 T组治疗有效率为97.22%,高于E组的87.50%,但差异无统计学意义(P>0.05)。T组手术时间为(31.53±7.29)分钟,术中出血量为(29.56±7.37)ml,手术当天、术后7天和14天创面面积分别为(10.03±0.96)cm~2、(8.76±0.87)cm~2和(6.20±0.77)cm~2,E组分别为(35.36±8.54)分钟、(36.86±8.04)ml、(12.09±1.23)cm~2、(10.52±1.09)cm~2和(7.36±0.85)cm~2,两组比较差异有统计学意义(P<0.05)。T组术后VAS评分、Wexner失禁评分分别为(1.38±0.27)分和(0.21±0.08)分,E组分别为(1.56±0.29)分和(0.33±0.09)分,T组20 mm处、30 mm处肛管直肠收缩压和20 mm处、30 mm处肛管直肠静息压分别为(138.18±29.58)mmHg、(136.22±35.41)mmHg、(35.47±6.58)mmHg和(32.97±8.01)mmHg,E组分别为(152.78±31.53)mmHg、(156.29±32.74)mmHg、(38.29±7.62)mmHg、(36.41±7.63)mmHg,两组评分和肛管直肠压力均下降,且T组低于E组,两组比较差异有统计学意义(P<0.05)。E组不良反应发生率(20.83%)高于F组的(13.89%),但差异无统计学意义(P>0.05)。结论 TROPIS治疗复杂性肛瘘的效果更好,能缩减手术时间,减少术中出血量,减轻术后疼痛,保护肛门功能。

不同手术方法对高位复杂性肛瘘患者肛门功能的影响

目的探讨传统切开挂线术和切开挂线选择性缝合术治疗高位复杂性肛瘘患者的效果。方法84例高位复杂性肛瘘患者按手术方式的不同分为两组,对照组采取传统切开挂线术治疗,研究组采取切开挂线选择性缝合术治疗,比较两组的治疗效果、疼痛程度、肛门功能、术后并发症。结果研究组的治疗总有效率明显高于对照组,术后7d的VAS评分、术后6个月的Wexner评分、术后并发症发生率均明显低于对照组(P<0.05)。结论与传统切开挂线术相比,切开挂线选择性缝合术治疗高位复杂性肛瘘患者的效果更好,可降低患者疼痛程度,改善肛门功能,降低术后并发症发生率。

磁共振多模态序列结合临床指标对复杂性肛瘘术后肛门排粪失禁复发预测研究

目的通过对多模态MRI指标与临床指标结合分析,建立复杂性肛瘘术后肛门排粪失禁预测模型,并对模型进行验证。方法回顾性分析2020年1月至2023年5月我院肛肠科收治的71例复杂性肛瘘患者资料。统计术后三个月是否有肛门失禁症状,根据肛门失禁进行分组,结合患者多模态MRI数据指标及临床指标等变量进行Logistic回归分析,建立术后肛门失禁预测模型。结果71例患者中,最终共纳入71人,其中男性65人,年龄21至63岁,平均年龄39.23±10.71岁,经括约肌型46例,括约肌上型25例。Logistic回归分析结果显示,MRI肛瘘分型、MRI病变直径、肛门外括约肌(exteral anal sphincter,EAS)萎缩分级、EAS厚度、年龄是复杂性肛瘘术后并发肛门失禁的独立危险因素(P<0.05)。依此进行因素筛选从而构建预测模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,曲线下面积(area under the curve,AUC)为0.940(P<0.001),模型预测质量评分0.87分,有较高的预测效能。结论MRI多模态成像指标结合临床风险因素建立的预测模型准确度良好,可以在治疗前方案的制订提供良好的影像学证据与参考,可以更好对肛门失禁情况进行提前预判。

118例婴幼儿复杂性肛瘘的临床特点及中医证型分布情况

目的探讨婴幼儿复杂性肛瘘的临床特点及中医证型分布情况。方法回顾性分析2019年1月1日到2023年1月1日在湖南中医药大学第二附属医院住院的118例复杂性肛瘘患儿的临床资料,分析其性别、年龄、瘘管、内外口及中医证型分布特点。结果118例患儿中男115例(97.5%),女3例(2.5%),性别比较差异有统计学意义(P<0.05);好发于1岁以内;其中低位复杂性肛瘘93例(占78.8%),高位复杂性肛瘘25例(占21.2%);以2根瘘管为主(占76.3%),其次为3根瘘管(占21.2%)和4根瘘管(占2.5%);内外口数量关系中以外口=内口为主(占71.2%),内外口多分布在3、9点位(截石位);中医证型以湿热下注证为主(占58.5%),其次为胎毒证(占23.7%)、脾虚湿蕴证(占17.8%)。结论婴幼儿复杂性肛瘘好发于1岁以内男性患儿,多为2根瘘管的低位复杂性肛瘘,内外口多分布在3、9点位(截石位),湿热下注证为主要中医证型。

MRI不同序列及图像融合技术在复杂性肛瘘中的应用价值

目的探讨MRI不同序列及图像融合技术在复杂性肛瘘中的应用价值。方法回顾性收集2022年6月至2023年10月在本院收治的复杂性肛瘘患者50例病历资料,术前均进行3D-SPACE-STIR、3D-SPACE-T2WI序列扫描,并进行图像融合,比较不同序列及图像融合技术对括约肌、瘘管及分支、括约肌+瘘管及分支清晰度评分,以及不同序列及图像融合技术对肛瘘内口和瘘管及分支的检出率。结果对于括约肌、瘘管及分支、括约肌+瘘管及分支清晰度评分,不同序列及图像融合技术之间比较差异均有统计学意义(P<0.05),其中3D-SPACE-T2WI、融合图清晰度评分均高于3D-SPACE-STIR(P<0.05);3D-SPACESTIR、3D-SPACE-T2WI、融合图对括约肌+瘘管及分支清晰度评分均高于括约肌、瘘管及分支(P<0.05),以手术诊断结果作为金标准,不同序列及图像融合技术对肛瘘内口和瘘管的检出率比较,差异均无统计学意义(P>0.05)。结论MRI不同序列及图像融合技术在复杂性肛瘘中诊断价值较高,具有较好的准确性。

改进经括约肌间瘘管结扎术治疗复杂性肛瘘的临床有效性和安全性评价

目的 探讨改进经括约肌间瘘管结扎术(LIFT)治疗复杂性肛瘘的临床有效性与安全性。方法 66例复杂性肛瘘患者,采用随机数字表法将患者分为对照组和观察组,每组33例。对照组给予常规LIFT治疗,观察组给予改进LIFT治疗。比较两组患者手术相关指标,近期疗效,肛管静息压、肛管收缩压,并发症发生情况。结果 两组手术时间、术中出血量、术后创面愈合时间、术后疼痛持续时间、术后住院时间对比无明显差异(P>0.05)。观察组总有效率为93.94%,明显高于对照组的75.76%(P<0.05)。术后3个月,对照组患者肛管静息压(55.63±8.24)mm Hg(1 mm Hg=0.133 kPa)、肛管收缩压(124.32±19.35)mm Hg与观察组患者的(55.72±8.56)、(124.52±19.58)mm Hg对比无明显差异(P>0.05)。观察组并发症发生率15.15%明显低于对照组的39.39%(P<0.05)。结论 改进LIFT对于复杂性肛瘘患者的临床疗效更为显著,安全性更高,且不会对肛门功能造成影响,利于患者身体的早日恢复,值得采纳并推广。

MRI在复杂性肛瘘术前诊断中的应用价值

目的 探究核磁共振成像(MRI)在复杂性肛瘘术前诊断中的应用价值。方法回顾性分析2022年8月至2023年7月来我院经手术证实为复杂性肛瘘患者92例资料,所有患者均于术前进行MRI检查。将MRI检查结果与手术结果进行比较,分析MRI对复杂性肛瘘诊断价值。结果经手术证实存在瘘管内口99个,外口78个,主瘘管111个、支瘘管11个,脓肿53个。与手术结果比较,MRI对患者瘘管、内口、外口、支瘘管、脓肿的诊断符合率为93.69%(P<0.05)、96.96%(P>0.05)、100.00%(P>0.05)、 100.00%(P> 0.05)、100.00%(P>0.05)。手术结果中,患者肛瘘Parks分型以括约肌间型(70.65%)为主,其次为经括约肌型(29.35%);MRI征象结果与手术结果比较,对肛瘘Parks分型的kappa值为0.973。结论MRI对复杂性肛瘘具有较高诊断价值,可明确患者分型,为手术提供更多信息,临床值得推广。

瘘管旷置术配合切开挂线疗法用于复杂性肛瘘治疗的临床效果及复发情况分析

目的 分析复杂性肛瘘治疗中应用瘘管旷置术配合切开挂线疗法的临床效果以及复发率情况。方法随机选取2021年1月—2022年12月烟台市市直机关医院收治的80例复杂性肛瘘患者为研究对象,依据手术方案的不同将其分为对照组与观察组,各40例。对照组应用单纯切开挂线疗法,观察组联合应用瘘管旷置术。评价两组患者的治疗效果与复发率、治疗指标、术后疼痛、睡眠情况、创面渗液情况。结果 观察组治疗有效率为97.50%(39/40),高于对照组的75.00%(30/40),差异有统计学意义(χ^(2)=8.538,P=0.003),观察组的手术时间长于对照组,术后下床时间、住院时间、创面愈合时间短于对照组,术中失血量高于对照组,差异有统计学意义(P均<0.05)。术后3 d、5 d和7 d,观察组的疼痛评分和睡眠质量评分低于对照组,差异有统计学意义(P均<0.05)。术后3 d、5 d和7 d,观察组的创面渗液评分低于对照组,差异有统计学意义(P均<0.05)。结论 复杂性肛瘘治疗中应用瘘管旷置术配合切开挂线疗法有助于减少患者手术造成的肛周损伤,提升治疗效果,减少术后疼痛与睡眠影响,且降低患者的复发率。

同期瘘管外切联合松挂线手术治疗复杂性肛瘘合并肛周脓肿的临床效果

目的:分析同期瘘管外切联合松挂线手术治疗复杂性肛瘘合并肛周脓肿的临床效果。方法:选取2022年1月—2023年1月中央财经大学校医院收治的复杂性肛瘘合并肛周脓肿患者60例作为研究对象,利用随机数字表法分为两组,每组30例。观察组同期进行瘘管外切联合松挂线手术治疗,对照组分期进行瘘管外切联合松挂线手术治疗。比较两组治疗效果。结果:观察组手术时间、创面愈合时间、总住院时间均短于对照组,差异有统计学意义(P<0.001)。观察组并发症总发生率低于对照组,差异有统计学意义(P=0.044)。观察组治疗总有效率高于对照组,差异有统计学意义(P=0.022)。结论:同期瘘管外切联合松挂线手术治疗复杂性肛瘘合并肛周脓肿的临床效果较好,手术时间短,能够促进患者恢复,减少并发症。

Parks松挂线术与分次紧线挂线法治疗高位复杂性肛瘘的效果比较

目的对比Parks松挂线术与分次紧线挂线法治疗高位复杂性肛瘘的效果。方法120例高位复杂性肛瘘患者随机分为两组,对照组采用Parks松挂线术进行治疗,研究组采用分次紧线挂线法进行治疗,比较两组的治疗效果、伤口愈合时间以及肛门功能。结果研究组的治疗总有效率高于对照组,伤口愈合时间长于对照组(P<0.05)。术后1个月,两组的Wexner评分均较治疗前降低(P<0.05),但组间差异无统计学意义(P>0.05)。结论Parks松挂线术与分次紧线挂线法均能有效改善高位复杂性肛瘘患者的肛门功能;相较于Parks松挂线术,分次紧线挂线法的疗效更好,但患者恢复时间相对较长。

湿润烧伤膏对复杂性肛瘘术后患者创面愈合的影响观察

目的:观察湿润烧伤膏对复杂性肛瘘患者术后创面愈合的影响。方法:选取2023年1—12月深圳市宝安区石岩人民医院收治的复杂性肛瘘术后患者90例作为研究对象,随机分为对照组和观察组,各45例。对照组行常规治疗,观察组在对照组基础上加用湿润烧伤膏治疗。比较两组术后第1、7、15天创面疼痛程度、分泌物pH值、水肿程度评分及康复指标水平。结果:术后第7、15天,两组视觉模拟评分法评分、创面分泌物pH值、创面水肿程度评分逐渐降低,观察组低于对照组,差异有统计学意义(P<0.05)。观察组坏死组织消失时间、创面愈合时间短于对照组,创面愈合率高于对照组,差异有统计学意义(P<0.05)。结论:复杂性肛瘘术后患者应用湿润烧伤膏治疗,可进一步缓解创面疼痛、水肿程度,降低创面分泌物pH值,促进坏死组织消失,加快创面愈合,提高术后创面愈合率。