改良后纵切横缝内括约肌切断术治疗肛裂的临床效果观察
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摘要
目的探讨改良后纵切横缝内括约肌切断术治疗肛裂的临床效果。方法将本院2014年3月至2016年9月收治的86例肛裂患者按随机数表法分为观察组(接受改良后纵切横缝内括约肌切断术)与对照组(接受开放式内括约肌切断术),每组各43例。比较两组临床疗效、手术相关指标、术后切口疼痛程度、排尿障碍情况、切口感染率,术后随访6个月,记录疗效及复发情况。结果两组总有效率比较差异无统计学意义(P> 0.05)。观察组创面愈合时间、住院时间均短于对照组,差异均有统计学意义(均P<0.05)。两组手术时间、术中出血量、肛周水肿时间差异均无统计学意义(均P> 0.05)。观察组在减轻术后切口疼痛程度、排尿障碍程度方面总体均优于对照组,差异均有统计学意义(均P<0.05)。两组切口感染发生率差异无统计学意义(P> 0.05)。随访6个月,两组均无复发病例,且控制排便功能良好,全部治愈。结论改良后纵切横缝内括约肌切断术治疗肛裂效果良好,与开放式内括约肌切断术相比,有利于减轻术后疼痛、减少术后排尿障碍及促进患者康复。
Objective To investigate the effect of modified longitudinal incision and transverse suture internal sphincterotomy in treating anal fissure. Methods 86 patients with anal fissure who were treated in our hospital from March 2014 to September 2016 were assigned using random number table to treatment group(received modified longitudinal incision and transverse suture internal sphincterotomy) and control group(received open internal sphincterotomy), with 43 patients in each group. Clinical effectiveness, indices related to operation, postoperative pain at incision, difficulties in urination, and incision infection were compared between the two groups. Patients were followed-up for 6 months and were evaluated for effectiveness and recurrence. Results Overall effectiveness was similar between the two groups(P > 0.05). Time to wound healing and duration of hospitalization were significantly shorter in the treatment group(P < 0.05). There was no significant difference in duration of operation, amount of blood loss, and duration of perianal edema between the two groups(P > 0.05). Patients in the treatment group had significantly lower pain and were significantly less likely to have difficulties in urination than patients in the control group(P < 0.05). Incidence of incision infection was similar between the two groups(P > 0.05). At follow-up of 6 months, there was no recurrence and all patients were healed with good defecation function.Conclusion There is favorable effect of modified longitudinal incision and transverse suture internal sphincterotomy in treating anal fissure. Compared with open internal sphincterotomy, it is beneficial in reducing postoperative pain and urination difficulties and promoting recovery.
Objective To investigate the effect of modified longitudinal incision and transverse suture internal sphincterotomy in treating anal fissure. Methods 86 patients with anal fissure who were treated in our hospital from March 2014 to September 2016 were assigned using random number table to treatment group(received modified longitudinal incision and transverse suture internal sphincterotomy) and control group(received open internal sphincterotomy), with 43 patients in each group. Clinical effectiveness, indices related to operation, postoperative pain at incision, difficulties in urination, and incision infection were compared between the two groups. Patients were followed-up for 6 months and were evaluated for effectiveness and recurrence. Results Overall effectiveness was similar between the two groups(P > 0.05). Time to wound healing and duration of hospitalization were significantly shorter in the treatment group(P < 0.05). There was no significant difference in duration of operation, amount of blood loss, and duration of perianal edema between the two groups(P > 0.05). Patients in the treatment group had significantly lower pain and were significantly less likely to have difficulties in urination than patients in the control group(P < 0.05). Incidence of incision infection was similar between the two groups(P > 0.05). At follow-up of 6 months, there was no recurrence and all patients were healed with good defecation function.Conclusion There is favorable effect of modified longitudinal incision and transverse suture internal sphincterotomy in treating anal fissure. Compared with open internal sphincterotomy, it is beneficial in reducing postoperative pain and urination difficulties and promoting recovery.
引文
[1]陈斌.后位内括约肌节段式部分切开术与后位内括约肌切开术治疗慢性肛裂疗效比较[J].新乡医学院学报,2015,32(9):871-873.
[2]安辉.开放式肛门内括约肌后位部分切开术治疗慢性肛裂的临床分析[J].检验医学与临床,2015,12(15):2251-2252.
[3]中华中医药学会肛肠专业委员会肛裂、直肠脱垂、肛瘘、痔的诊断标准(试行草案)[C].全国大肛肛门病学术研讨会,2003:313-314.
[4]上海市卫生局.上海市中医病证诊疗常规[M].上海:上海中医药大学出版社,2003:328-329
[5]艾正友.男性低位直肠癌根治术保留盆腔自主神经对排尿及性功能的影响[J].河北医学,2015,21(3):445-448.
[6] SAITO N, SARASHINA H, NUNOMURA M, et al. Clinical evaluation of nerve-sparing surgery combined with preoperative radiotherapy in advanced rectal cancer patients[J]. American Journal of Surgery,1998,175(4):277-282.
[7]中华人民共和国卫生部.医院感染诊断标准(试行)摘登(1)[J].新医学,2005,36(8):495-495.
[7]曾建成,曾俊.内括约肌侧切除术治疗慢性肛裂的临床疗效分析[J].结直肠肛门外科,2015,21(1):56-57.
[8]黄继承.自拟止痛润肠汤治疗37例肛裂的临床效果观察[J].贵州医药,2017,41(5):510-511.
[9]范茹英,张高高,康瑞,等.康复新液用于早期肛裂保守治疗的临床观察[J].山西医药杂志,2015,44(6):665-667.
[10] LIANG J, CHURCH J M. Lateral internal sphincterotomy for surgically recurrent chronic anal fissure[J].American Journal of Surgery,2015,210(4):715-719.
[11]安辉.开放式肛门内括约肌后位部分切开术治疗慢性肛裂的临床分析[J].检验医学与临床,2015,12(15):2251-2252.
[12] GANDOMKAR H, ZEINODDINI A, HEIDARI R, et al.Partial lateral internal sphincterotomy versus combined botulinum toxin A injection and topical diltiazem in the treatment of chronic anal fissure:a randomized clinical trial[J].Diseases of the Colon&Rectum,201558(2):228-234.
[13]黄宇峰.改良纵切横缝内括约肌切断术在慢性肛裂患者治疗中的应用研究[J].中国医师进修杂志,2013,36(32):59-60.
[14]杨雅琴,钟锋,李荣,等.直肠癌Miles术后会阴部伤口愈合缓慢的影响因素分析[J].蚌埠医学院学报,2017,42(1):61-63.
[15]于德明,姜国丹,刘慧峰.两种手术方法治疗老年人肛裂的临床疗效比较[J].中华老年医学杂志,2017,36(8):889-891.
[16] EMILE S H. Indications and technical aspects of internal anal sphincterotomy:highlighting the controversies[J].Diseases of the Colon&Rectum,2017,60(1):128.
[2]安辉.开放式肛门内括约肌后位部分切开术治疗慢性肛裂的临床分析[J].检验医学与临床,2015,12(15):2251-2252.
[3]中华中医药学会肛肠专业委员会肛裂、直肠脱垂、肛瘘、痔的诊断标准(试行草案)[C].全国大肛肛门病学术研讨会,2003:313-314.
[4]上海市卫生局.上海市中医病证诊疗常规[M].上海:上海中医药大学出版社,2003:328-329
[5]艾正友.男性低位直肠癌根治术保留盆腔自主神经对排尿及性功能的影响[J].河北医学,2015,21(3):445-448.
[6] SAITO N, SARASHINA H, NUNOMURA M, et al. Clinical evaluation of nerve-sparing surgery combined with preoperative radiotherapy in advanced rectal cancer patients[J]. American Journal of Surgery,1998,175(4):277-282.
[7]中华人民共和国卫生部.医院感染诊断标准(试行)摘登(1)[J].新医学,2005,36(8):495-495.
[7]曾建成,曾俊.内括约肌侧切除术治疗慢性肛裂的临床疗效分析[J].结直肠肛门外科,2015,21(1):56-57.
[8]黄继承.自拟止痛润肠汤治疗37例肛裂的临床效果观察[J].贵州医药,2017,41(5):510-511.
[9]范茹英,张高高,康瑞,等.康复新液用于早期肛裂保守治疗的临床观察[J].山西医药杂志,2015,44(6):665-667.
[10] LIANG J, CHURCH J M. Lateral internal sphincterotomy for surgically recurrent chronic anal fissure[J].American Journal of Surgery,2015,210(4):715-719.
[11]安辉.开放式肛门内括约肌后位部分切开术治疗慢性肛裂的临床分析[J].检验医学与临床,2015,12(15):2251-2252.
[12] GANDOMKAR H, ZEINODDINI A, HEIDARI R, et al.Partial lateral internal sphincterotomy versus combined botulinum toxin A injection and topical diltiazem in the treatment of chronic anal fissure:a randomized clinical trial[J].Diseases of the Colon&Rectum,201558(2):228-234.
[13]黄宇峰.改良纵切横缝内括约肌切断术在慢性肛裂患者治疗中的应用研究[J].中国医师进修杂志,2013,36(32):59-60.
[14]杨雅琴,钟锋,李荣,等.直肠癌Miles术后会阴部伤口愈合缓慢的影响因素分析[J].蚌埠医学院学报,2017,42(1):61-63.
[15]于德明,姜国丹,刘慧峰.两种手术方法治疗老年人肛裂的临床疗效比较[J].中华老年医学杂志,2017,36(8):889-891.
[16] EMILE S H. Indications and technical aspects of internal anal sphincterotomy:highlighting the controversies[J].Diseases of the Colon&Rectum,2017,60(1):128.