括约肌间瘘管结扎术结合脱细胞异体真皮基质填塞治疗经括约肌肛瘘的疗效分析
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摘要
目的探讨括约肌间瘘管结扎术(LIFT)结合瘘管脱细胞异体真皮基质(AEM)填塞治疗经括约肌肛瘘的临床疗效。方法选取2013年10月-2016年10月该院收治的66例经括约肌肛瘘患者。采用随机数字表法将患者分为治疗组(行LIFT和AEM)和对照组(行肛瘘切开术或切开挂线术),每组各33例。主要观察指标:创面愈合时间,术前、术后1、3、6、12个月肛门失禁评分和总有效率。患者术后1个月至门诊复诊,术后3、6、12个月采用门诊、问卷及电话方式进行随访,了解创面愈合情况、肛门控便能力及治愈情况。结果筛选出符合研究条件的患者61例,治疗组31例,对照组30例,两组患者术前均无肛门失禁。对照组30例患者中,21例行肛瘘切开术,9例行切开挂线术。两组创面愈合时间比较,差异有统计学意义(P <0.05),治疗组少于对照组。肛门失禁评分两组术前比较差异无统计学意义(P>0.05),两组术后肛门失禁评分比较,差异有统计学意义(P <0.05),治疗组术后1、3、6、12个月肛门失禁评分均低于对照组。治疗组和对照组总有效率分别为90.32%和93.33%,两组比较,差异无统计学意义(P>0.05)。结论 LIFT结合AEM治疗经括约肌肛瘘与传统肛瘘切开术疗效相当,而且创面愈合时间短,肛门功能保护良好,无肛门失禁的发生。
Objective To explore the clinical effect of ligation of the intersphincteric fistula tract(LIFT) combined with acellular extracellular matrix(AEM) tamponade in the treatment of transsphincteric fistula. Methods The clinical data of 66 patients with transsphincteric fistula who were admitted to the Sichuan Provincial People's Hospital between October 2013 and October 2016 were collected. All the patients were allocated into a treatment group(undergoing LIFT combined with AEM) and a control group(undergoing fistulotomy or incision-threaddrawing procedure) according to random number table, with 33 patients in each group. The main observation indices included wound healing time, anal incontinence scores before operation and at postoperative month 1, 3, 6 and 12, and total effective rate. The outpatient examination was conducted at postoperative month 1; questionnaires, outpatient examination and telephone interview were performed to detect wound healing, anal control ability and healing situation at postoperative month 3, 6 and 12. Results Of the 66 patients, 61 patients were screened out for eligibility including 31 patients in the treatment group and 30 patients in the control group, there was no occurrence of preoperative anal incontinence. In the control group 21 patients underwent fistulotomy and 9 patients received incision-thread-drawing procedure. Wound healing time in the treatment group was shorter than that in the control group, with a statistically significant difference between the two groups(P < 0.05). There were no statistic differences in the preoperative anal incontinence scores between the two groups(P > 0.05), whereas the anal incontinence scores in the treatment group were significantly lower than those in the control group at postoperative month 1, 3, 6 and 12(P < 0.05). The total effective rates of the treatment group and the control group were 90.32% and 93.33% respectively, there was no significant difference between the two groups(P > 0.05). Conclusions LIFT combined with AEM in the treatment of transsphincteric fistula has the same clinical effect as fistulotomy and incision-threaddrawing procedure, and has the advantages of sphincter-preserving, shorter wound healing time and better anal control ability, without the occurrence of anal incontinence.
Objective To explore the clinical effect of ligation of the intersphincteric fistula tract(LIFT) combined with acellular extracellular matrix(AEM) tamponade in the treatment of transsphincteric fistula. Methods The clinical data of 66 patients with transsphincteric fistula who were admitted to the Sichuan Provincial People's Hospital between October 2013 and October 2016 were collected. All the patients were allocated into a treatment group(undergoing LIFT combined with AEM) and a control group(undergoing fistulotomy or incision-threaddrawing procedure) according to random number table, with 33 patients in each group. The main observation indices included wound healing time, anal incontinence scores before operation and at postoperative month 1, 3, 6 and 12, and total effective rate. The outpatient examination was conducted at postoperative month 1; questionnaires, outpatient examination and telephone interview were performed to detect wound healing, anal control ability and healing situation at postoperative month 3, 6 and 12. Results Of the 66 patients, 61 patients were screened out for eligibility including 31 patients in the treatment group and 30 patients in the control group, there was no occurrence of preoperative anal incontinence. In the control group 21 patients underwent fistulotomy and 9 patients received incision-thread-drawing procedure. Wound healing time in the treatment group was shorter than that in the control group, with a statistically significant difference between the two groups(P < 0.05). There were no statistic differences in the preoperative anal incontinence scores between the two groups(P > 0.05), whereas the anal incontinence scores in the treatment group were significantly lower than those in the control group at postoperative month 1, 3, 6 and 12(P < 0.05). The total effective rates of the treatment group and the control group were 90.32% and 93.33% respectively, there was no significant difference between the two groups(P > 0.05). Conclusions LIFT combined with AEM in the treatment of transsphincteric fistula has the same clinical effect as fistulotomy and incision-threaddrawing procedure, and has the advantages of sphincter-preserving, shorter wound healing time and better anal control ability, without the occurrence of anal incontinence.
引文
[1]张东铭,主编.盆底肛直肠外科理论与临床[M].北京:人民军医出版社,2011:110.
[2]谭嗣伟,梁存河,陈志雨,等.脱细胞异体真皮基质材料治疗复杂肛瘘52例[J].中国微创外科杂志,2012,12(3):228.
[3]WILLIAMS J G,FARRANDS P A,WILLIAMS A B,el a1.The treatment of anal fistula:ACPGBI position statement[J].Colorectal Dis,2007,9(Suppl 4):18-50.
[4]ROJANASAKUL A,PATTANAARUN J,SAHAKITRUN-GRUANG C,et a1.Total anal sphincter saving technique for fistula-in-ano:the ligation of intersphincteric fistula tract[J].J Med Assoc Thai,2007,90(3):581-586.
[5]HONG K D,KANG S,KALASKAR S,et a1.Ligation of intersphincteric fistula tract(LIFT)to treat anal fistula:systematic review and meta-analysis[J].Tech Coloproctol,2014,18(8):685-691.
[6]潘春来,黄大年,袁和学.改良经括约肌间瘘管结扎术治疗肛瘘的临床疗效分析[J].中华胃肠外科杂志,2015,18(12):1268-1270.
[7]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.
[8]曹吉勋,主编.新编中国痔瘘学[M].四川:四川科学技术出版社,2015:165-168.
[9]JORGE J M,WEXNER S D.Etiology and management of fecal incontinence[J].Dis Colon Rectum,1993,36:77-97.
[10]SHANWANI A,NOR A M,AMRI N.Ligation of the intersphincteric fistula tract(LIFT):a sphincter-saving technique for fistula-in-ano[J].Dis Colon Rectum,2010,53:39-42.
[11]ABOULIAN A,KAJI A H,KUMAR R R.Early result of ligation of the intersphincteric fistula tract for fistula-in-ano[J].Dis Colon Rectum,2011,54:289-292.
[12]TAN K K,TAN I J,LIM F S,et a1.The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula:a review of 93 patients over 4 years[J].Dis Colon Rectum,2011,54(11):1368-1372.
[13]TSUNODA A,SADA H,SUGIMOTO T,et al.Anal function after ligation of the intersphincteric fistula tract[J].Dis Colon Rectum,2013,56(7):898-902.
[14]郑毅,王振军,杨新庆,等.改良括约肌间瘘管结扎术治疗慢性肛瘘的随机对照多中心临床观察[J].中华医学杂志,2015,95(42):3454-3457.
[15]林家威,吴鸿根,黄顺荣,等.脱细胞异体直皮基质填塞与切开挂线术治疗肛瘘的对比研究[J].微创医学,2013,8(6):687-688.
[16]胡云龙,马木提江·阿巴拜克热,艾尔哈提·胡赛音,等.脱细胞异体真皮基质填塞术治疗高位肛瘘的临床疗效[J].医学研究杂志,2016,45(2):75-78.
[17]韩加刚,王振军,赵宝成,等.脱细胞异体真皮基质治疗肛瘘的愈合机制研究[J].中华胃肠外科杂志,2011,14(12):964-967.
[18]VERGARA-FERNANDEZ O,ESPINO-URBINA L A.Ligation of intersphincteric fistula tract:what is the evidence in a review[J].World J Gastroenterol,2013,19(40):6805-6813.
[19]周雪涛,郑毅,崔金杰,等.LIFT-plug术治疗慢性单纯性肛瘘的疗效研究[J].北京医学,2017,39(1):60-64.
[2]谭嗣伟,梁存河,陈志雨,等.脱细胞异体真皮基质材料治疗复杂肛瘘52例[J].中国微创外科杂志,2012,12(3):228.
[3]WILLIAMS J G,FARRANDS P A,WILLIAMS A B,el a1.The treatment of anal fistula:ACPGBI position statement[J].Colorectal Dis,2007,9(Suppl 4):18-50.
[4]ROJANASAKUL A,PATTANAARUN J,SAHAKITRUN-GRUANG C,et a1.Total anal sphincter saving technique for fistula-in-ano:the ligation of intersphincteric fistula tract[J].J Med Assoc Thai,2007,90(3):581-586.
[5]HONG K D,KANG S,KALASKAR S,et a1.Ligation of intersphincteric fistula tract(LIFT)to treat anal fistula:systematic review and meta-analysis[J].Tech Coloproctol,2014,18(8):685-691.
[6]潘春来,黄大年,袁和学.改良经括约肌间瘘管结扎术治疗肛瘘的临床疗效分析[J].中华胃肠外科杂志,2015,18(12):1268-1270.
[7]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.
[8]曹吉勋,主编.新编中国痔瘘学[M].四川:四川科学技术出版社,2015:165-168.
[9]JORGE J M,WEXNER S D.Etiology and management of fecal incontinence[J].Dis Colon Rectum,1993,36:77-97.
[10]SHANWANI A,NOR A M,AMRI N.Ligation of the intersphincteric fistula tract(LIFT):a sphincter-saving technique for fistula-in-ano[J].Dis Colon Rectum,2010,53:39-42.
[11]ABOULIAN A,KAJI A H,KUMAR R R.Early result of ligation of the intersphincteric fistula tract for fistula-in-ano[J].Dis Colon Rectum,2011,54:289-292.
[12]TAN K K,TAN I J,LIM F S,et a1.The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula:a review of 93 patients over 4 years[J].Dis Colon Rectum,2011,54(11):1368-1372.
[13]TSUNODA A,SADA H,SUGIMOTO T,et al.Anal function after ligation of the intersphincteric fistula tract[J].Dis Colon Rectum,2013,56(7):898-902.
[14]郑毅,王振军,杨新庆,等.改良括约肌间瘘管结扎术治疗慢性肛瘘的随机对照多中心临床观察[J].中华医学杂志,2015,95(42):3454-3457.
[15]林家威,吴鸿根,黄顺荣,等.脱细胞异体直皮基质填塞与切开挂线术治疗肛瘘的对比研究[J].微创医学,2013,8(6):687-688.
[16]胡云龙,马木提江·阿巴拜克热,艾尔哈提·胡赛音,等.脱细胞异体真皮基质填塞术治疗高位肛瘘的临床疗效[J].医学研究杂志,2016,45(2):75-78.
[17]韩加刚,王振军,赵宝成,等.脱细胞异体真皮基质治疗肛瘘的愈合机制研究[J].中华胃肠外科杂志,2011,14(12):964-967.
[18]VERGARA-FERNANDEZ O,ESPINO-URBINA L A.Ligation of intersphincteric fistula tract:what is the evidence in a review[J].World J Gastroenterol,2013,19(40):6805-6813.
[19]周雪涛,郑毅,崔金杰,等.LIFT-plug术治疗慢性单纯性肛瘘的疗效研究[J].北京医学,2017,39(1):60-64.