改良括约肌间瘘管结扎术与肛瘘切开挂线术的临床对照
|
摘要
目的:对比改良括约肌间瘘管结扎术与肛瘘切开挂线术的疗效。方法:106例复杂肛瘘患者随机分为A组与B组,各53例,A组采取改良括约肌间瘘管结扎术治疗,B组采取肛瘘切开挂线术治疗,比较两组痊愈率、术后第3 d及第7 d的疼痛VAS评分、住院时间、创口愈合时间、手术前后Wexner肛门失禁评分及随访1年的复发率。结果:A组痊愈率与复发率(96.23%、5.66%)与B组(94.33%、7.55%)相比均无统计学意义(P>0.05);A组术后第3 d与第7 d的VAS评分[(2.82±0.80)分、(1.03±0.31)分]均低于B组[(3.61±0.77)分、(2.26±0.44)分,(P<0.05)];A组住院时间、创口愈合时间[(14.53±2.49)d、(18.62±3.77)d]均短于B组[(18.51±4.66)d、(23.17±5.08)d,(P<0.05)];出院时两组Wexner评分均大幅下降(P<0.05),A组[(0.22±0.07)分]低于B组[(0.30±0.09)分](P<0.05)。结论:较之肛瘘切开挂线术,改良括约肌间瘘管结扎术在减轻术后疼痛、缩短住院时间与创口愈合时间及改善术后肛门功能方面均有较大优势。
Objective To compare the clinical effects of modified ligation of the intersphincteric fistula tract and incision-thread-drawing procedure.Methods Total 106 patients with complex anal fistula were selected as study subjects and were randomized divided into group A and group B by the random number table method, 53 cases in each group. Group A was treated with modified ligation of the intersphincteric fistula tract while group B was treated with incision-thread-drawing procedure. The cure rate and VAS pain scores 3d and7 d postoperative, hospitalization time, wound healing time, Wexner anal incontinence scores preoperative and postoperative and 1-year recurrence rate were compared between the two groups.Results There were no significant differences between the cure rate and recurrence rate of group A(96.23%, 5.66%) and group B(94.33%, 7.55%)(P > 0.05). The VAS pain scores 3d and 7d postoperative of group A(2.82±0.80, 1.03±0.31)were lower than group B(3.61±0.77, 2.26±0.44)(P < 0.05). The hospitalization time and wound healing time in group A [(14.53 ± 2.49) d,(18.62 ± 3.77) d] were shorter than those in group B[(18.51 ± 4.66) d,(23.17 ± 5.08) d](P < 0.05). On discharge, Wexner scores of both groups were significantly decreased(P < 0.05). The Wexner score of group A(0.22±0.07) was lower than group B(0.30±0.09)(P < 0.05).Conclusion Compared with incision-thread-drawing procedure, modified ligation of the intersphincteric fistula tract has more advantages in reducing postoperative pain, shortening the hospitalization time and wound healing time and improving the anal function after surgery.
Objective To compare the clinical effects of modified ligation of the intersphincteric fistula tract and incision-thread-drawing procedure.Methods Total 106 patients with complex anal fistula were selected as study subjects and were randomized divided into group A and group B by the random number table method, 53 cases in each group. Group A was treated with modified ligation of the intersphincteric fistula tract while group B was treated with incision-thread-drawing procedure. The cure rate and VAS pain scores 3d and7 d postoperative, hospitalization time, wound healing time, Wexner anal incontinence scores preoperative and postoperative and 1-year recurrence rate were compared between the two groups.Results There were no significant differences between the cure rate and recurrence rate of group A(96.23%, 5.66%) and group B(94.33%, 7.55%)(P > 0.05). The VAS pain scores 3d and 7d postoperative of group A(2.82±0.80, 1.03±0.31)were lower than group B(3.61±0.77, 2.26±0.44)(P < 0.05). The hospitalization time and wound healing time in group A [(14.53 ± 2.49) d,(18.62 ± 3.77) d] were shorter than those in group B[(18.51 ± 4.66) d,(23.17 ± 5.08) d](P < 0.05). On discharge, Wexner scores of both groups were significantly decreased(P < 0.05). The Wexner score of group A(0.22±0.07) was lower than group B(0.30±0.09)(P < 0.05).Conclusion Compared with incision-thread-drawing procedure, modified ligation of the intersphincteric fistula tract has more advantages in reducing postoperative pain, shortening the hospitalization time and wound healing time and improving the anal function after surgery.
引文
[1]王岩,孙松.微创手术与常规切开挂线手术治疗复杂肛瘘的比较分析[J].临床外科杂志,2016,24(1):63-64.
[2]陈朝文.复杂肛瘘的治疗[J].中国普外基础与临床杂志,2010,17(2):119-121.
[3]方晓东.不同手术方式治疗高位复杂肛瘘的疗效观察[J].中国医药导刊,2011,13(12):2058,2060.
[4]汪挺,兰平.2006中国结直肠肛门外科学术会议纪要[J].中华胃肠外科杂志,2007,10(1):89-90.
[5]徐靖,陈胜波,孙栋森,等.高位复杂肛瘘的治疗[J].中国医刊,2011,46(9):31-35.
[6]吴祚辉,孔令韬.高位复杂肛瘘紧线时机的临床研究[J].环球中医药,2013,6(S1):134-134.
[7]周云,王永福,缪家明,等.切开旷置加中位虚挂引流术治疗高位复杂肛瘘的临床疗效分析[J].安徽医学,2016,37(9):1150-1151.
[8]王良兵,彭兰,除永强,等.留桥切挂缝合术治疗复杂性肛瘘[J].四川医学,2012,33(1):76-77.
[9]曾翔辉,武彪,刘羽,等.经括约肌间瘘管结扎术联合负压封闭引流治疗复杂性肛瘘疗效观察[J].山东医药,2014,54(46):48-49.
[10]孙薛亮,文科,杨柏霖,等.改良括约肌间瘘管结扎术治疗复杂性肛瘘[J].中华普通外科杂志,2016,31(5):398-401.
[11]陈红锦,谷云飞,孙桂东,等.经括约肌间瘘管结扎术治疗复杂性肛瘘[J].中华胃肠外科杂志,2014,17(12):1190-1193.
[12]刘锋华.结扎术配合补片与肛瘘切开挂线术治疗肛瘘的疗效及安全性对比研究[J].中国中西医结合外科杂志,2015,21(6):606-608.
[13]马英.分段开窗旷置对口引流切开挂线联合中药治疗复杂性肛瘘148例[J].西部中医药,2013,26(6):78-80.
[14]刘佃温,潘慧.切开挂线术联合中药坐浴治疗高位肛瘘临床研究[J].中医学报,2012,27(3):296-297.
[15]彭健,张勇,陈亚军,等.括约肌间瘘管结扎术与切开挂线术治疗复杂性肛瘘的疗效比较[J].现代生物医学进展,2014,14(18):3502-3504.
[16]孙薛亮,王晓鹏,文科,等.括约肌间瘘管结扎术治疗复杂性肛瘘临床疗效分析[J].临床外科杂志,2015,23(9):694-696.
[17]尹和宅,陈会林,刘铫,等.对口切开瘘管潜行剥离术治疗低位复杂性肛瘘的临床观察[J].中国中西医结合外科杂志,2015,21(2):179-180.
[18]徐征.同期多切口切开挂线引流术治疗高位复杂性肛瘘58例临床观察[J].四川医学,2012,33(9):1606-1607.
[2]陈朝文.复杂肛瘘的治疗[J].中国普外基础与临床杂志,2010,17(2):119-121.
[3]方晓东.不同手术方式治疗高位复杂肛瘘的疗效观察[J].中国医药导刊,2011,13(12):2058,2060.
[4]汪挺,兰平.2006中国结直肠肛门外科学术会议纪要[J].中华胃肠外科杂志,2007,10(1):89-90.
[5]徐靖,陈胜波,孙栋森,等.高位复杂肛瘘的治疗[J].中国医刊,2011,46(9):31-35.
[6]吴祚辉,孔令韬.高位复杂肛瘘紧线时机的临床研究[J].环球中医药,2013,6(S1):134-134.
[7]周云,王永福,缪家明,等.切开旷置加中位虚挂引流术治疗高位复杂肛瘘的临床疗效分析[J].安徽医学,2016,37(9):1150-1151.
[8]王良兵,彭兰,除永强,等.留桥切挂缝合术治疗复杂性肛瘘[J].四川医学,2012,33(1):76-77.
[9]曾翔辉,武彪,刘羽,等.经括约肌间瘘管结扎术联合负压封闭引流治疗复杂性肛瘘疗效观察[J].山东医药,2014,54(46):48-49.
[10]孙薛亮,文科,杨柏霖,等.改良括约肌间瘘管结扎术治疗复杂性肛瘘[J].中华普通外科杂志,2016,31(5):398-401.
[11]陈红锦,谷云飞,孙桂东,等.经括约肌间瘘管结扎术治疗复杂性肛瘘[J].中华胃肠外科杂志,2014,17(12):1190-1193.
[12]刘锋华.结扎术配合补片与肛瘘切开挂线术治疗肛瘘的疗效及安全性对比研究[J].中国中西医结合外科杂志,2015,21(6):606-608.
[13]马英.分段开窗旷置对口引流切开挂线联合中药治疗复杂性肛瘘148例[J].西部中医药,2013,26(6):78-80.
[14]刘佃温,潘慧.切开挂线术联合中药坐浴治疗高位肛瘘临床研究[J].中医学报,2012,27(3):296-297.
[15]彭健,张勇,陈亚军,等.括约肌间瘘管结扎术与切开挂线术治疗复杂性肛瘘的疗效比较[J].现代生物医学进展,2014,14(18):3502-3504.
[16]孙薛亮,王晓鹏,文科,等.括约肌间瘘管结扎术治疗复杂性肛瘘临床疗效分析[J].临床外科杂志,2015,23(9):694-696.
[17]尹和宅,陈会林,刘铫,等.对口切开瘘管潜行剥离术治疗低位复杂性肛瘘的临床观察[J].中国中西医结合外科杂志,2015,21(2):179-180.
[18]徐征.同期多切口切开挂线引流术治疗高位复杂性肛瘘58例临床观察[J].四川医学,2012,33(9):1606-1607.