摘要
目的：低位单纯性肛瘘是肛肠科临床常见疾病之一,常采用传统的肛瘘切开术来治疗。尽管肛瘘切开术疗效肯定,但存在着术后创面愈合时间长、肛门外形及功能有可能损伤的不足。为了探讨一种既能治愈肛瘘,又能减少术后创伤、增加患者术后的舒适度、缩短创面愈合时间,且对肛门外观及功能的维护优于传统肛瘘切开术的新方法,我们设计了本试验。
方法：选取符合纳入标准的低位单纯性肛瘘患者40例,随机分为2组,治疗组和对照组各20例。治疗组采用内口荷包缝合加肛瘘切除全层缝合术,对照组采用肛瘘切开术。观察比较手术后两组患者的总疗效、术后疼痛程度、渗血情况、疼痛持续时间、创画愈合时间、术后肛门外观及肛门功能等情况。
结果：治疗组在术后疼痛程度、疼痛持续时间、术后创面愈合时间、术后疤痕面积大小肛门外观及功能方面优于对照组；而在总疗效、治愈率、复发率等方面,两组间差异无统计学意义。
结论：1、内口荷包缝合加肛瘘切除全层缝合术治疗低位单纯性肛瘘与传统的肛瘘切开术相比,术后创伤小、创面愈合时间短、术后患者的舒适度、对肛门外观及功能的维护优于肛瘘切开术。2、与传统的肛瘘切开术相比较,总疗效、复发率相当,且不增加术后并发症
Objective:Lower simple anal fistula is one of diseases which are common in clinic, it is often traeted by the traditional fistulectomy. Although fistulectomy can cure anal fistula, Its deficiency contains that the time of wound healing is longer after operation and can trauma anal function.We design this trial to evaluate a new operation procedure in the treatment of anal fistula that can guarantee the healing rate, reduce trauma and suffering, shorten time of treatment,and can much more protect anal appearance and function than the traditional fistulectomy.
Methods:40samples are randomly divided into two groups.The therapy group and the control group are have20sample sseparately.The therapy group adopts the procedure of suturing inner jaw pouch-like and suturing all-layers wound.The control group adopts fistulectomy. Observing and analyzing the clinical curative effect,pain and bleeding after operation,time of pain and treatment,postoperative anal appearance and function.
Results:Compared with the two groups, The postoperative pain,time of pain and treatment, postoper-ative scar area and anal appearance and function are obvious different(P<0.05).They have no obvious differences in the clinical curative effect,curing rate and recurrence (P>0.05).
Conclusion:1.The procedure of suturing inner jaw pouch-like and suturing all-layers wound can reduce trauma and suffering, shorten time of treatment,and can much more protect anal appearance and function than the.2.Compared with the two groups,they are no difference in clinical curative effect and recurrence, the procedure of suturing inner jaw pouch-like and suturing all-layers wound did not increase postoperative complications.
引文
[1]黄乃健主编.中国肛肠病学[M].济南：山东科学技术出版社,1996:729.
[2]李雨农.中华肛肠病学[M].北京：科学技术文献出版社，1990:366.
[3]胡伯虎.大肠肛门病治疗学[M].北京：科学技术文献出版社,2004.7:312.
[4]Adams D.Kovalcik PJ.Fistula in ano.Surg Gyneeol Obstet 1981; 153:731-2.
[5]Chiari H.Uber die Nalen Divertikel der Rectumsch-leimhaut und ihre Beziehung zu den Anal Fisrein.Med lahrbucher Wien 1878;8:419-27.
[6]Eisenhammer S.The internal anal sphincter and the anorectal absess.Surg Gynecol Dbstet 1956;103:501-6.
[7]Dunphy JE.Surgical anatomy of the anal canal.Arch Surg 1948:57:791-800.
[8]Parks AG Pathogenesis and treatment of fistula-in-ano.Br Med J 1961;1:463-9.
[9]唐学贵,伍静等.中西医结合诊治高位复杂性肛瘘[J].川北医学院学报.2007,2(1):2.
[10]Goligher JC,et al.Seton treatment of high anal fistulse[J].Br J Surg,1991 (78):1159-1161.
[11]张东铭.大肠肛门局部解剖与手术学[M].合肥：安徽科学技术出版社,1998:96.
[12]Edwadrs S.On some of the rarer fooms of rectal fistulae. Lancet 1987.1:1089.
[13]Weisman R1.Orsay CP,Pearl RK, Abcarian H.The role of fistulography in fistula-in-ano. Dis Colon Rectum 11991;34:181-4.
[14]Hasegawa H.Radley S.Keighley MR.Long-term results of cutting seton fistulotomy.Acta Chir lugosl, 2000,47(1):19.
[15]Garcia J.Davey CS.Le CT.et al. Patient satisfaction after surgery-factors associated fistula-in-ano.Dis Colon Rectum,2000,43(9):1206.
[16]Isbister WH.Fistula-in-ano.Aust N Z J Surg,1999,69 (11):768.
[17]胡良胜,左志贵,胡波.肛瘘切除一期缝合术的临床应用[J].湖北中医杂志.2005.27(8):41.
[18]牟齐蓉,谭婷婷,王晓林.瘘管切开基底缝合引流术治疗低位肛瘘的临床研究[J].结直肠肛门外科.2007.13(1)：32-34.
[19]杨青山.开窗引流加挂线术治疗复杂性肛瘘疗效观察[J].临床合理用药,2011,7(4):87.
[20]Parks.A.Q;Br.Med.J.1961,5224:463.
[21]史兆歧等.中国大肠肛门病学[M].郑州：河南科技出版社,1985:93.
[22]高野正博.外科治疗[J],1987.5:532.
[23]Elting Aw,Ann Surg,1912;56;744.
[24]Reznick PK.etal.Dis Colon Rectum.1988,31:16.
[25]Shemsh El.etal.Dis Colon Rectum.1988.31:22.
[26]Mann CV,et al:Br.j.Sueg,1985,72(2):134
[27]何春梅,陆金根,曹永清等.隧道式主管拖线术治疗单纯性肛瘘疗效和生活质量评价[J].中国中西医结合外科杂志2007，13(4):329-332.
[28]臧传波,温春燕,李荣等.直肠内推进瓣修补高位肛瘘6例临床观察[J].山东医药,2007,47(12):64.
[29]Abbas MA,Lemus-Rangel R,Hamadani A.Long-term outcome of endorectal advancement flap for complex anorectal fistulae[J].Am Surg.2008 Oct;74(10):921.
[30]胡克,肖成.皮瓣内移封闭内口术治疗高位肛瘘的临床研究[J].内蒙古医学杂志,2008,40(12):1480.
[31]PATRLJL.KOCMAN B,MARTrNAC M,et al.Fibrin glue-antibiotic mixture in the treatment of anal fistulae:experience with 69 cases[J].Dig Surg,2000,17(1):77-80.
[32]SCHWANDNER T,ROBLICK MH.KIERER W,et al.Surgical treatment of complex anal fistulas with the anal fistula plug:a prospective,multicenter study[J].Dis Co-Ion Rectum,2009,52(9):1578-1583.
[33]Rojnasakul A.LIFT procedure:a simplified technique for fistula-in-ano[J].Tech Coloproctol.2009, 13(3):237-240.
[34]杜培欣，汪庆明.改良LIFT术治疗肛瘘的临床观察[J].结直肠肛门外科，2011,17(5):324.
[35]王振军.肛瘘治疗新手术LIFT-Plug术[J].中国临床医生,2011，39(8):8-9.
[36]KehletH,W ilmore DW.Multimodal strategies to improve surgical outcome.Am J Surg,2002,183: 630-641.
[37]陈立红,邓瑛钒.荷包缝合法在小面积圆形创面修复术中的应用[J].中国美容医学,2007,4(16):417.
[38]王元钊.复发性肛瘘的诊疗体会[J].江西中医药,2006,6(6):46-47.