截径（挂线）隧道式对口浮线引流术治疗高位后蹄铁型肛瘘的临床研究
|
摘要
目的:观察和评价截径(挂线)隧道式对口浮线引流术治疗高位后蹄铁型肛瘘的术式优劣及临床疗效。
方法:将40例高位后蹄铁型肛瘘患者随机分成试验组和对照组,其中试验组20例采用截径(挂线)隧道式对口浮线引流术,对照组20例采用弧形切缝(挂线)内口引流术。观察两组病例的疗效、手术操作性、术后反应及并发症、伤口愈合情况、肛门功能及随访半年内的复发情况等,应用统计学软件SPSS13.0对结果进行分析,以α=0.05为水准进行双侧检验。
结果:试验组在手术时间、术中出血、术后第2-4天疼痛、切口水肿等方面明显优于对照组,存在显著性差异(P＜0.05);对照组在愈合时间上明显优于试验组(P＜0.05);而在术后当天疼痛、排尿障碍、术后继发感染、肛门功能、疗效及随访复发情况等方面两组无显著差异(P＞0.05)。而从总体疗效的加权评分来看,两组无统计学差异(P＞0.05)。
结论:截径(挂线)隧道式对口浮线引流术在治疗高位后蹄铁型肛瘘上,不仅能达到了根治肛瘘和良好地保护肛门功能的有机统一,而且在术式上有明显的优势如可操作性强,损伤小等,并且有效减少术后并发症的发生,证明了截径(挂线)隧道式对口浮线引流术是治疗高位后蹄铁型肛瘘的优良术式。
Objective:To observe and assess the therapeutic effect of the modus operandi with intercept the trail,tie the muscle and with a floating-rubber tissue in the tunnel for contra-aperture drainageing and the forte or the shortage of it in the treatment of posterior horseshoe anal fistula of superior position.
Methods:The 40 cases of posterior horseshoe anal fistula of superior position were randomly divided into trials group and controlled group,20 cases in trials group received the modus operandi with intercept the trail,tie the muscle and with a floating-rubber tissue in the tunnel for contra-aperture drainageing,20 cases in controlled group received the modus operandi with arc incisions sutured.To observe the curative effect、the operability of operative procedure、the afterreaction and complication of operative procedure、the status of wound healing and the anal disfunction and the relapse rate in six months.The relative results were calculated statistically with SPSS13.0 software.Statistical standard was accepted as the "α" value equal 0.05 for double tailed test.
Results:The trials group surpass the controlled group in the aspects of the time of the operation、the volume of blood loss in operation and in the postoperative pain in the following three days after the first day of operation,The hydropsia of incisal opening(P＜0.05),The controlled group surpass the trials group in the aspects of the time of the healing(P＜0.05),There was no difference between the two groups in the postoperative pain in the first day,the retention of urine,the secondary infection,the anal disfunction,the curative effect and the relapse rate in six months(P＞0.05).And in the whole,scored with weighting,there was no difference between the two groups(P＞0.05).
Conclusion:The modus operandi with intercept the trail,tie the muscle and with a floating-rubber tissue in the tunnel for contra-aperture drainageing could not only protect the anal function and give anal fistula a radical cure but also have evident technical dominance,such as the advangtage in manipuility,the smaller lesions in operation,and so on,Furthermore it effectively prevent the postoperative complications.In all,the modus operandi with intercept the trail,tie the muscle and with a floating-rubber tissue in the tunnel for contra-aperture drainageing should be a superordinary technique in in the treatment of posterior horseshoe anal fistula of superior position.
方法:将40例高位后蹄铁型肛瘘患者随机分成试验组和对照组,其中试验组20例采用截径(挂线)隧道式对口浮线引流术,对照组20例采用弧形切缝(挂线)内口引流术。观察两组病例的疗效、手术操作性、术后反应及并发症、伤口愈合情况、肛门功能及随访半年内的复发情况等,应用统计学软件SPSS13.0对结果进行分析,以α=0.05为水准进行双侧检验。
结果:试验组在手术时间、术中出血、术后第2-4天疼痛、切口水肿等方面明显优于对照组,存在显著性差异(P＜0.05);对照组在愈合时间上明显优于试验组(P＜0.05);而在术后当天疼痛、排尿障碍、术后继发感染、肛门功能、疗效及随访复发情况等方面两组无显著差异(P＞0.05)。而从总体疗效的加权评分来看,两组无统计学差异(P＞0.05)。
结论:截径(挂线)隧道式对口浮线引流术在治疗高位后蹄铁型肛瘘上,不仅能达到了根治肛瘘和良好地保护肛门功能的有机统一,而且在术式上有明显的优势如可操作性强,损伤小等,并且有效减少术后并发症的发生,证明了截径(挂线)隧道式对口浮线引流术是治疗高位后蹄铁型肛瘘的优良术式。
Objective:To observe and assess the therapeutic effect of the modus operandi with intercept the trail,tie the muscle and with a floating-rubber tissue in the tunnel for contra-aperture drainageing and the forte or the shortage of it in the treatment of posterior horseshoe anal fistula of superior position.
Methods:The 40 cases of posterior horseshoe anal fistula of superior position were randomly divided into trials group and controlled group,20 cases in trials group received the modus operandi with intercept the trail,tie the muscle and with a floating-rubber tissue in the tunnel for contra-aperture drainageing,20 cases in controlled group received the modus operandi with arc incisions sutured.To observe the curative effect、the operability of operative procedure、the afterreaction and complication of operative procedure、the status of wound healing and the anal disfunction and the relapse rate in six months.The relative results were calculated statistically with SPSS13.0 software.Statistical standard was accepted as the "α" value equal 0.05 for double tailed test.
Results:The trials group surpass the controlled group in the aspects of the time of the operation、the volume of blood loss in operation and in the postoperative pain in the following three days after the first day of operation,The hydropsia of incisal opening(P＜0.05),The controlled group surpass the trials group in the aspects of the time of the healing(P＜0.05),There was no difference between the two groups in the postoperative pain in the first day,the retention of urine,the secondary infection,the anal disfunction,the curative effect and the relapse rate in six months(P＞0.05).And in the whole,scored with weighting,there was no difference between the two groups(P＞0.05).
Conclusion:The modus operandi with intercept the trail,tie the muscle and with a floating-rubber tissue in the tunnel for contra-aperture drainageing could not only protect the anal function and give anal fistula a radical cure but also have evident technical dominance,such as the advangtage in manipuility,the smaller lesions in operation,and so on,Furthermore it effectively prevent the postoperative complications.In all,the modus operandi with intercept the trail,tie the muscle and with a floating-rubber tissue in the tunnel for contra-aperture drainageing should be a superordinary technique in in the treatment of posterior horseshoe anal fistula of superior position.
引文
1.胡伯虎主编.大肠肛门病治疗学[M].北京:科学技术文献出版社,2004:318
2.李春雨,张有生主编.实用肛门手术学[M].沈阳:辽宁科学技术出版社,2005;176.
3.张东铭主编.盆底与肛门病学[M].贵阳:贵州科技出版社,2000:471
4.胡伯虎主编.大肠肛门病治疗学[M].北京:科学技术文献出版社,2004:352
5.王晓林.现代肛肠科学.成都中医药大学,2004:128
6.国家中医药管理局.中华人民共和国中医药行业标准[S].南京:南京大学出版社,1994:132
7.刘俊青、邹魁英、李贵信.痔瘘围手术期镇痛治疗[J].中国肛肠病杂志,2002,22(3):22-23
8.王晏美,安阿玥,范学顺.不同术式治疗高位肛瘘98例临床观察[J].北京中医药大学学报,2005,(3).
9.王胜文.3种术式治疗后位马蹄型肛瘘的临床观察[J].大肠肛门病外科杂志,2003,9(3):175
10.黄乃健主编.中国肛肠病学[M].山东:山东科学技术文献出版社,1996
11.史兆岐主编.中国大肠肛门病学.郑州:河南科学技术出版社,1985:663
12.曹吉勋主编.中国痔瘘学.成都:四川科学技术出版社。1985:193-194
13.张东铭主编.盆底与肛门病学[M].贵阳:贵州科技出版社,2000:243
14.董平.旷置引流法治疗复杂性肛瘘38例.中国肛肠病杂志,2000,20(5):26.
15.张东铭主编.大肠肛门局部解剖与手术学[M].合肥:安徽科学技术出版社,2006:15
16.张东铭主编.盆底与肛门病学[M].贵阳:贵州科技出版社,2000:435
17.张庆荣主编.临床肛门大肠外科学[M].天津:天津科技翻译出版公司,1992:101
18.黄乃健主编.中国肛肠病学[M].山东:山东科学技术文献出版社,1996:745-766
19.安阿钥主编.肛肠病学(第2版)[M].北京:人民卫生出版社,2005.481.
20.丁义江主编.丁氏肛肠病学[M].北京:人民卫生出版社,2006.273
21.曹永清,陆金根.隧道式对口引流发治疗多支管复杂性肛瘘147例[J].上海中医药杂志,1998,44(10):43
22.杜再坪等.内口切开并药线挂线治疗高位复杂性肛瘘30例[J].中国中医急症,2004,13(4):250.
23.赵晓中.切挂旷置术治疗高位复杂性肛瘘62例体会[J].长治医学院学报,2005,19(3):210.
24.李春雨.切开挂线对口引流治疗高位复杂性肛瘘179例[J].大肠肛门病外科杂志,2002,8(3):167.
25.喻德洪主编.肛管直肠瘘(肛瘘).黄家驷外科学(第6版)[M].北京:人民卫生出版社,2000:1170-1174
26.丁义江主编.丁氏肛肠病学[M].北京:人民卫生出版社,2006.276
27.胡伯虎主编.大肠肛门病治疗学[M].第一版.北京:科技文献出版社,2001:312
28.钱海华,黄继诚,谷云飞,等.高位虚挂引流术治疗高位肛瘘59例临床观察[J].中国肛肠病杂志,2005,25(5):9-10.
29.董平.肛管直肠动力学在肛瘘手术中的意义[J].中国实用外科杂志,1998,18(9):552.
30.李一兵,王国昌,李达难,等.高位肛瘘括约肌无损伤根治术的临床研究[J].中国肛肠病杂志,2004,24(8):23-24.
31.Klug W.Recurrent anal fistulas surgical concept and late results.Zentralbl Chir,1999 124(2):39
32.胡良胜等.肛瘘切除一期缝合与敞开疗法的临床比较研究[J].中国肛肠病杂志,2004,24(5):7-8
33.李雨农主编.中华肛肠病学.重庆:科学技术文献出版社,1990:371
34.Willian C.Challenging the predictive accuracy of Goodsall's rule for anal fistulas.Dis Colon Rectum,1992,35:537-540
35.赵自星主编.实用肛瘘学.成都:四川科学技术出版社,2003:184
36.张书信,温小一.浮紧配合挂线治疗蹄铁型肛门直肠脓肿-瘘58例[J].中国临床医生,2004.32(7):52-53
37.陈薇薇.低位截断切开隧道引流高位挂线治疗高位肛瘘34例[J].上海中医药杂志,2004.38(4):29-31.
38.徐本健等.改道切开保留皮桥加皮筋引流法治疗蹄铁型复杂性肛瘘53例[J].中国肛肠病杂志,2003.23(5):9-10
39.吴阶平,裘法祖主编.黄家驷外科学(第4版)[M].北京:人民卫生出版社1986:1157
40.张立新,柳东杨.复杂性肛瘘的治疗体会[J].新中医,1996增刊:147-148
41.郑卫平等.改良式肛瘘切除缝合术治疗肛瘘368例[J].中国肛肠病杂志,2003.23(5):14-15
42.李小林.低切高挂半缝合半开放引流术治疗高位肛瘘[J].大肠肛门病外科杂志,2002.8(3):157-158
43.陆一,安敏.改进肛瘘切缝内口(挂线)引流术治疗马蹄形肛瘘的临床观察[J].成都中医药大学学报,2000.23(2):24-25
1.荣文舟.中华肛肠病学图谱[M].北京:科学技术文献出版社,1993:
2.李雨农.中华肛肠病学[M].重庆:科学技术文献出版社重庆分社,1990:
3.丁泽民,丁义江,王业皇.丁氏痔科学[M].上海:上海科学技术出版社,1989:
4.胡伯虎,李宁汉.实用痔瘘学[M].北京:科学技术文献出版社,1998:
5.任东林.有关马蹄形肛瘘治疗的几个问题[J].广东医学,2001,22(12):1093
6.王晓林.现代肛肠科学.成都中医药大学,2004:
7.周毅,付声珏.肛瘘内口位置的确定与处理[J].大肠肛门病外科杂志,2003,9(3):167-169
8.张东铭.盆底与肛门病学[M].贵州:贵州科技出版社,2000:
9.粱健民.切挂开窗引流术治疗马蹄形肛瘘的临床研究[J].大肠肛门病外科杂志,2000,6(2):25-26.
10.李裕,邢美娟.双氧水在肛瘘诊治中的应用[J].中国肛肠病杂志,1995,15(3):8
11.吴阶平,裘法祖.黄家驷外科学[M].北京:人民卫生出版社,1999:
12.Cirocco WC,Rcillv JW.Challanging the predictive accuracy of Gooclsall's rule for anal fistulas[J].BDis Colon Rectun,1992,35(6):537
13.张大俊,王培军等.螺旋CT三维重建技术在肛瘘诊断中的应用[J].中国实用外科杂志,2001,21(11):673-674
14.Chao DY.Endosonographic:criteria for an internal opening of fistula-in-ano[J].Dis Colon Rectum,1999,42(4):515
15.Deen KI,Williams JG,Hutchinson R,et al.Fistula-in-ano:endoanal ultrasonographic assessment assists decisionmaking for surgery[J].Cut,1994,35(3):391
16.王振军,杨斌,年卫东等.肛门内镜超声检查对内口愈合的肛瘘的诊断价值[J].中国实用外科杂志,2001,2(11):658
17.王士孝,胡金玲.双氧水声学造影B超显像确定肛瘘内口[J].中国肛肠病杂志,1993,13(3):33
18.金伟森,金英.B超检查肛瘘的临床小结[J].中国肛肠病杂志,1996,16(1):50
19.杨光,赵跃华,王为等.直肠腔内超声法在高位肛瘘诊断中的应用[J].中国肛肠病杂志,2002,22(5):3
20.许长年,梁建成.高频线阵型超声波在肛瘘诊断中的应用[J].大肠肛门病外科杂志,2004,10(1):28-30
21.王为,杨光,令狐庆等.肛瘘疾病的超声诊断价值[J].中国肛肠病杂志,2001,21(5):6-7
22.徐道明,李升明.经肛管腔内超声过氧化氢增强造影诊断肛瘘的价值[J].中国超声医学杂志,2001,17(9):705-707
23.Stoker J,Hussain SM,Lameris JS.Endoanal magnetic resonanceimaging versus endosonography[J].Radiol Med Torino,1996,92(6):738
24.胡丰良,吴印爱,刘献棠等.超高位多瘘管复杂性肛门直肠瘘的综合治疗311例报告[J].中华普通外科杂志,1999,14(4):257-259
25.艾中立,钱群.肛瘘复发的原因与对策[J].大肠肛门病外科杂志,2002,8(3):143
26.胡道予.肛瘘的影像学诊断[J].放射学实践,2002,17(2):153-155
27.Bects-Tan RG,Bects GL,Vander-Hoop AG,et al.High resolution magnetic resonance imaging of the anorectal without an endocoil[J].Abdom Imaging,1999,24(6):576
28.Spencer JA,Ward J,Beckingham IJ,et al.Dynamic contrastenhanced MR Imaging of perianal fistulas[J].AJR,1996,167:735
29.Myhr GE,Myrvold HE,Nilsen G,et al.Perianal fistulas.Use of MR Imaging for diagnosis[J].Radiology,1994,191:545
30.Hussain SM,Syoker J,Schouten WR,et al.Fistula in ano:Endoanal Sonography versus endoanal MR imaging in classification[J].Radiology,1996,200:475
31.Navanna G,Ascanelli S,Turini A,et al.Mucinous adenocarcinomain chronic anorectal fistula[J].Chir Ital,1999,51(5):413
32.丁义江.马蹄形肛瘘的诊治进展[J].大肠肛门病外科杂志,2002,8(3):138-139
33.E.Mylonakis,C.Katsios,D.Godevenos,et al.Quality of life of patients after surgical treatment of anal fistula;the role of anal manometry[J].Colorectal Disease,2001,3(6):417
34.赵自星主编.实用肛瘘学[M].成都:四川科学技术出版社,2003:100-101
35.D'Hoore A,Penninck F.The pathology of complex fistula in ano[J].Acta CHir Belg,2000,100(3):111
36.唐宗江.肛瘘的诊断与治疗原则[J].中国实用外科杂志,2001,21(11):64-71
37.胡伯虎主编.大肠肛门病治疗学[M].北京:科学技术文献出版社,2001:324
38.黄乃健主编.中医肛肠病学[M].科学出版社,1996:245-246
39.秦兵芬.68例高位肛瘘术后从脾论治体会[J].四川中医,2001,19(12):60-61
40.谢国良.低位切开加五五丹引流治疗高位肛瘘60例[J].河北中医,2003,25(4):300-301
41.张平生.中西医结合治疗高位肛瘘181例[J].辽宁中医杂志,2001,28(9):552
42.黄乃健主编.中国肛肠病学.山东科学技术出版社,1994.753
43.郭荣.改良式切开挂线术配中药坐浴洗剂治疗高位肛瘘43例[J].陕西中医,2005,26(11):1183-1184
44.乔敬华.手术治疗669例肛瘘的体会[J].中华临床医药杂志,2005,16(10):41-43
45.栗军.高位挂线低位切开半开放改道引流治疗肛瘘[J].中华中西医杂志,2004,5(17):1917-1918
46.乔敬华.括约肌切断术式治疗肛瘘的体会[J].四川中医,2003,21(11):77-78
47.张宝庭.高位低缝治疗复杂性肛瘘180例[J].中国肛肠病杂志,2004,24(5):12-13
48.李敏.切开选择缝合术治疗高位复杂性肛瘘的临床研究[J].中国肛肠病杂志,2004,24(5):3-5
49.陆金根主编.大肠肛门病研究新进展[M].上海中医药大学出版社,2003:223-224. 外科杂志,2005,11(1):57-58
51.梁健民.切挂开窗引流术治疗高位复杂性肛瘘的临床研究[J].大肠肛门病外科杂志,2000,6(2):25-28
52.Deroide,-G.Fistulas et baeesde l' anus:asPectsdiagnosti ques et priciples therapuetiques,en dehors de la maladie de Crohn.J-Chir-(Paris).2000Apr;137(2):83-92
53.Hjortrup A,Moesgaard F et al.Fibrin adhesive in the treatment of perineal fistulas[J].Dis Colon rectum,1991,34:752-4
54.Abel ME,Chiu YS,Russell TR,et al.Autologous fibrin glue in the treatment of rectovaginal and complex fistulas[J].Dis Colon Rectum,1993,36:447-9
55.Cintron JR,ParkJJ,Orsay CP,et al.Repair of fistulas-in-anousing autologous fibrin tissue adhesive.Dis Colon Rectum[J].1999,42:607-613
56.Stephon M.Sentovich MD.Fibrin glue for anal fistula and long term results[J].Dis Colon Rectum,2003,46(4):498-502
57.Ian Lindsey,MM Smilgin-Humphreys,C Cunningham,et al.A randomized controlled trial of fibrin glue vs conventional treatment for anal fidtula[J].Dis Colon Rectum,2002,45(12):1608-1615
58.Sentocich SM.Dis Colon Rectum,2003,46(4):441-446
59.杨军,杨淼.福爱乐医用胶粘堵治疗肛瘘10例临床观察[J].临床外科杂志,2004,12(3):180
60.Venkatesh KS,Ramanujam P.Fibrin glue application in the treatment of recurrent anorectal fistulas[J].Dis Colon Rectum,1999,42:1136-1139
61.Cintron JR,Park JJ,Orsay CP,et al.Repair of Fistulas in ano using autologous fibrin tissue adhesive[J].Dis Colon Rectum,1999,42:607-13
62.Cintron JR,Park JJ,Orsay CP,et al.Repair of Fistulas in ano using fibrin adhesive[J].Dis Colon Rectum,2000,43:944-50
63.江厚象,王东,潘凯.分期手术并用纤维蛋白胶治疗复杂肛瘘的应用体会[J].大肠肛门病外科杂志,2004,10(1):58-59
64.K.M.CHAN,C.W.LAU,K.K.T.LAI,et al.Preliminary results of using a commercial fibrin sealant in the treatment of fistula-in-ano[J].JR Coll Surg Edinb,2002,47(1):407-10
65.Marc Singer,Jose Cintron,Richard Nelson,et al.Treatment of Fistulas-in-ano with Fibrin Sealant in Combination with Intra-adhesive Antibiotics and/or Surgical Closure of the Internal Fistula Opening[J].Diseases of the Colon & Rectum,2005,48(4):799-808
66.Rasmy Loungnarath,David W.Dietz,Matthew G.Mutch,Elisa H.Birnbaum,Ira J.Kodner,James W.Fleshmam.Dis Colon Rectum,2004,47(4):432-436
67.Oded Zmora,et al.Fibrin glue sealing in the treatment of perineal fistulas[J].Dis Colon Rectum,2003,46(5):584-589
68.刘承椿.介入放射法在治疗肛瘘中的应用[J].福建医药杂志,1999,21(5):61-62
69.王巧兮,任开明,李茂进.介入放射治疗肛瘘的临床研究[J].中国医学影像技术,1999,15(12):931-932
70.高峰,李文慧,印建国.介入治疗复杂性肛门直肠瘘5例报告[J].大肠肛门病外科杂志,2001,7(4):22-23
71.宋致辉,孙淑英,陈维萍,等.CO_2激光治疗肛瘘及肛裂[J].滨州医学院学报,2000,23(4):359
72.姚长虹.CO_2激光治疗肛瘘132例[J].中国激光医学杂志,2001,10(2):131
73.胡伯虎.大肠肛门病治疗学[M].北京:科技文献出版社,2001:352-353
74.朱建平,杨明忠.半开放缝合挂线术后治疗高位后蹄铁型肛瘘临床分析[J].航空航天医药,2003,4:21-22
75.陆一,安敏,赵自星.改进肛瘘切缝内口(挂线)引流术治疗马蹄形肛瘘的临床观察[J].成都中医药大学学报,2000,2:25-26
76.周恒.手术治疗后位马蹄型肛瘘的临床观察(附32例报告)[J].海南医学,2002,13(9):89-90
77.HANLEY PH.Dis Colon Rectum,1965,8:364
78.高野正博.外科治疗[M].1987:532
79.GOLIGHER JC.Surg of the Anus Rectum and Colon[M].4th ed.London:Balliere Tindal,1-1980
80.宇井本.…大肠肛门志,1982,35:305
81.黄明,张卫萍,陈斌武,等.低切高挂开窗留桥引流术治疗后位蹄铁型肛瘘63例[J].新疆中医药,2004,6:34-35
82.何德才,王惠君,商义.切开挂线皮桥旷置治疗马蹄型肛瘘临床疗效观察[J].川北医学院学报,2002,17(1):73-74
83.高见.开窗留桥拖挂术治疗马蹄型肛瘘[J].中国中西医结合外科杂志,2000,6121:127
84.李丽莉.150例蹄铁型肛瘘的治疗[J].现代医药卫生,2004,2:112
85.任锈稼.开窗留桥术治疗蹄铁型肛瘘186例临床观察[J].实用医技杂志,2004,15:67
86.黄伟.切开挂线隧道引流术治疗高位后蹄铁型肛瘘45例[J].黑龙江中医药,2004,1:29-30
87.杨勇军,唐学贵,李敏,等.切挂对口橡皮引流术治疗高位后马蹄型肛瘘临床观察[J].大肠肛门病外科杂志,2004,4:55-56
88.周立青,张效东,战晶涛,等.开窗搔刮挂线术治疗后马蹄型肛瘘43例[J].吉林医学,2005,26(2):220
89.张立军.外切内挂术治疗马蹄型肛瘘48例分析[J].郴州医学高等专科学校学报,2004,6(1):45
90.何春梅,曹永清,陆金根.隧道式拖线加内口切挂术治疗后位马蹄型肛瘘46例[J].上海中医药杂志,2004,38(6):32-33
91.赵自星,罗励,杨亚莎,等.高位后马蹄型肛瘘治疗方法的探讨[M].大肠肛门病研究新进展.上海:上海中医药大学出版社,2003:232-233
92.赵自星.实用肛瘘学[M].成都:四川科学技术出版社,2003
93.李平举,王云英等.红粉化腐膏及生肌散在肛瘘术后的应用[J].长春中医学院学报,2001,17(4):35
94.李美英,何昌国.自制祛腐生肌高促进肛瘘创面愈合的临床观察[J].中国中医药科技,2001,8(2):119-120
95.王爱华,李帅军,王真权等.银灰膏对肛瘘术后50例创面换药疗效观察[J].新中医,2003,35(4):21-22
96.封以生,张镇国.锡类散用于肛瘘术后换药的疗效分析[J].黑龙江中医药,2002:62
97.杨黎明.红油膏和三石粉用于肛瘘术后换药40例[J].湖南中医杂志,2003,19(1):45
98.龚德怡.痔科外洗方坐浴加快肛瘘术后创口愈合[J].天津中医药,2004,21(3):209
99.陈学玲.西瓜霜粉剂用户肛瘘术后换药的疗效观察[J].赫尔滨医药,2001,21(4):60
100.赵承竹.藻酸钙伤口敷料对肛瘘术后创面愈合作用的临床观察[J].上海医学,2003,26(6):321
100.孙建华,高凌卉.复方甲基纤维素促进肛瘘术后创面愈合的疗效分析[J].上海中医药杂志,2003,37(3):37
101.屈艳,胡英娥.贝复济促进肛瘘术后创面愈合的临床观察[J].江西医药,2004,39(6):464-465
102.卞守华,欧阳卫东.肛瘘588例诊治体会[J].内蒙古医学杂志,2004,36(3):212-214
2.李春雨,张有生主编.实用肛门手术学[M].沈阳:辽宁科学技术出版社,2005;176.
3.张东铭主编.盆底与肛门病学[M].贵阳:贵州科技出版社,2000:471
4.胡伯虎主编.大肠肛门病治疗学[M].北京:科学技术文献出版社,2004:352
5.王晓林.现代肛肠科学.成都中医药大学,2004:128
6.国家中医药管理局.中华人民共和国中医药行业标准[S].南京:南京大学出版社,1994:132
7.刘俊青、邹魁英、李贵信.痔瘘围手术期镇痛治疗[J].中国肛肠病杂志,2002,22(3):22-23
8.王晏美,安阿玥,范学顺.不同术式治疗高位肛瘘98例临床观察[J].北京中医药大学学报,2005,(3).
9.王胜文.3种术式治疗后位马蹄型肛瘘的临床观察[J].大肠肛门病外科杂志,2003,9(3):175
10.黄乃健主编.中国肛肠病学[M].山东:山东科学技术文献出版社,1996
11.史兆岐主编.中国大肠肛门病学.郑州:河南科学技术出版社,1985:663
12.曹吉勋主编.中国痔瘘学.成都:四川科学技术出版社。1985:193-194
13.张东铭主编.盆底与肛门病学[M].贵阳:贵州科技出版社,2000:243
14.董平.旷置引流法治疗复杂性肛瘘38例.中国肛肠病杂志,2000,20(5):26.
15.张东铭主编.大肠肛门局部解剖与手术学[M].合肥:安徽科学技术出版社,2006:15
16.张东铭主编.盆底与肛门病学[M].贵阳:贵州科技出版社,2000:435
17.张庆荣主编.临床肛门大肠外科学[M].天津:天津科技翻译出版公司,1992:101
18.黄乃健主编.中国肛肠病学[M].山东:山东科学技术文献出版社,1996:745-766
19.安阿钥主编.肛肠病学(第2版)[M].北京:人民卫生出版社,2005.481.
20.丁义江主编.丁氏肛肠病学[M].北京:人民卫生出版社,2006.273
21.曹永清,陆金根.隧道式对口引流发治疗多支管复杂性肛瘘147例[J].上海中医药杂志,1998,44(10):43
22.杜再坪等.内口切开并药线挂线治疗高位复杂性肛瘘30例[J].中国中医急症,2004,13(4):250.
23.赵晓中.切挂旷置术治疗高位复杂性肛瘘62例体会[J].长治医学院学报,2005,19(3):210.
24.李春雨.切开挂线对口引流治疗高位复杂性肛瘘179例[J].大肠肛门病外科杂志,2002,8(3):167.
25.喻德洪主编.肛管直肠瘘(肛瘘).黄家驷外科学(第6版)[M].北京:人民卫生出版社,2000:1170-1174
26.丁义江主编.丁氏肛肠病学[M].北京:人民卫生出版社,2006.276
27.胡伯虎主编.大肠肛门病治疗学[M].第一版.北京:科技文献出版社,2001:312
28.钱海华,黄继诚,谷云飞,等.高位虚挂引流术治疗高位肛瘘59例临床观察[J].中国肛肠病杂志,2005,25(5):9-10.
29.董平.肛管直肠动力学在肛瘘手术中的意义[J].中国实用外科杂志,1998,18(9):552.
30.李一兵,王国昌,李达难,等.高位肛瘘括约肌无损伤根治术的临床研究[J].中国肛肠病杂志,2004,24(8):23-24.
31.Klug W.Recurrent anal fistulas surgical concept and late results.Zentralbl Chir,1999 124(2):39
32.胡良胜等.肛瘘切除一期缝合与敞开疗法的临床比较研究[J].中国肛肠病杂志,2004,24(5):7-8
33.李雨农主编.中华肛肠病学.重庆:科学技术文献出版社,1990:371
34.Willian C.Challenging the predictive accuracy of Goodsall's rule for anal fistulas.Dis Colon Rectum,1992,35:537-540
35.赵自星主编.实用肛瘘学.成都:四川科学技术出版社,2003:184
36.张书信,温小一.浮紧配合挂线治疗蹄铁型肛门直肠脓肿-瘘58例[J].中国临床医生,2004.32(7):52-53
37.陈薇薇.低位截断切开隧道引流高位挂线治疗高位肛瘘34例[J].上海中医药杂志,2004.38(4):29-31.
38.徐本健等.改道切开保留皮桥加皮筋引流法治疗蹄铁型复杂性肛瘘53例[J].中国肛肠病杂志,2003.23(5):9-10
39.吴阶平,裘法祖主编.黄家驷外科学(第4版)[M].北京:人民卫生出版社1986:1157
40.张立新,柳东杨.复杂性肛瘘的治疗体会[J].新中医,1996增刊:147-148
41.郑卫平等.改良式肛瘘切除缝合术治疗肛瘘368例[J].中国肛肠病杂志,2003.23(5):14-15
42.李小林.低切高挂半缝合半开放引流术治疗高位肛瘘[J].大肠肛门病外科杂志,2002.8(3):157-158
43.陆一,安敏.改进肛瘘切缝内口(挂线)引流术治疗马蹄形肛瘘的临床观察[J].成都中医药大学学报,2000.23(2):24-25
1.荣文舟.中华肛肠病学图谱[M].北京:科学技术文献出版社,1993:
2.李雨农.中华肛肠病学[M].重庆:科学技术文献出版社重庆分社,1990:
3.丁泽民,丁义江,王业皇.丁氏痔科学[M].上海:上海科学技术出版社,1989:
4.胡伯虎,李宁汉.实用痔瘘学[M].北京:科学技术文献出版社,1998:
5.任东林.有关马蹄形肛瘘治疗的几个问题[J].广东医学,2001,22(12):1093
6.王晓林.现代肛肠科学.成都中医药大学,2004:
7.周毅,付声珏.肛瘘内口位置的确定与处理[J].大肠肛门病外科杂志,2003,9(3):167-169
8.张东铭.盆底与肛门病学[M].贵州:贵州科技出版社,2000:
9.粱健民.切挂开窗引流术治疗马蹄形肛瘘的临床研究[J].大肠肛门病外科杂志,2000,6(2):25-26.
10.李裕,邢美娟.双氧水在肛瘘诊治中的应用[J].中国肛肠病杂志,1995,15(3):8
11.吴阶平,裘法祖.黄家驷外科学[M].北京:人民卫生出版社,1999:
12.Cirocco WC,Rcillv JW.Challanging the predictive accuracy of Gooclsall's rule for anal fistulas[J].BDis Colon Rectun,1992,35(6):537
13.张大俊,王培军等.螺旋CT三维重建技术在肛瘘诊断中的应用[J].中国实用外科杂志,2001,21(11):673-674
14.Chao DY.Endosonographic:criteria for an internal opening of fistula-in-ano[J].Dis Colon Rectum,1999,42(4):515
15.Deen KI,Williams JG,Hutchinson R,et al.Fistula-in-ano:endoanal ultrasonographic assessment assists decisionmaking for surgery[J].Cut,1994,35(3):391
16.王振军,杨斌,年卫东等.肛门内镜超声检查对内口愈合的肛瘘的诊断价值[J].中国实用外科杂志,2001,2(11):658
17.王士孝,胡金玲.双氧水声学造影B超显像确定肛瘘内口[J].中国肛肠病杂志,1993,13(3):33
18.金伟森,金英.B超检查肛瘘的临床小结[J].中国肛肠病杂志,1996,16(1):50
19.杨光,赵跃华,王为等.直肠腔内超声法在高位肛瘘诊断中的应用[J].中国肛肠病杂志,2002,22(5):3
20.许长年,梁建成.高频线阵型超声波在肛瘘诊断中的应用[J].大肠肛门病外科杂志,2004,10(1):28-30
21.王为,杨光,令狐庆等.肛瘘疾病的超声诊断价值[J].中国肛肠病杂志,2001,21(5):6-7
22.徐道明,李升明.经肛管腔内超声过氧化氢增强造影诊断肛瘘的价值[J].中国超声医学杂志,2001,17(9):705-707
23.Stoker J,Hussain SM,Lameris JS.Endoanal magnetic resonanceimaging versus endosonography[J].Radiol Med Torino,1996,92(6):738
24.胡丰良,吴印爱,刘献棠等.超高位多瘘管复杂性肛门直肠瘘的综合治疗311例报告[J].中华普通外科杂志,1999,14(4):257-259
25.艾中立,钱群.肛瘘复发的原因与对策[J].大肠肛门病外科杂志,2002,8(3):143
26.胡道予.肛瘘的影像学诊断[J].放射学实践,2002,17(2):153-155
27.Bects-Tan RG,Bects GL,Vander-Hoop AG,et al.High resolution magnetic resonance imaging of the anorectal without an endocoil[J].Abdom Imaging,1999,24(6):576
28.Spencer JA,Ward J,Beckingham IJ,et al.Dynamic contrastenhanced MR Imaging of perianal fistulas[J].AJR,1996,167:735
29.Myhr GE,Myrvold HE,Nilsen G,et al.Perianal fistulas.Use of MR Imaging for diagnosis[J].Radiology,1994,191:545
30.Hussain SM,Syoker J,Schouten WR,et al.Fistula in ano:Endoanal Sonography versus endoanal MR imaging in classification[J].Radiology,1996,200:475
31.Navanna G,Ascanelli S,Turini A,et al.Mucinous adenocarcinomain chronic anorectal fistula[J].Chir Ital,1999,51(5):413
32.丁义江.马蹄形肛瘘的诊治进展[J].大肠肛门病外科杂志,2002,8(3):138-139
33.E.Mylonakis,C.Katsios,D.Godevenos,et al.Quality of life of patients after surgical treatment of anal fistula;the role of anal manometry[J].Colorectal Disease,2001,3(6):417
34.赵自星主编.实用肛瘘学[M].成都:四川科学技术出版社,2003:100-101
35.D'Hoore A,Penninck F.The pathology of complex fistula in ano[J].Acta CHir Belg,2000,100(3):111
36.唐宗江.肛瘘的诊断与治疗原则[J].中国实用外科杂志,2001,21(11):64-71
37.胡伯虎主编.大肠肛门病治疗学[M].北京:科学技术文献出版社,2001:324
38.黄乃健主编.中医肛肠病学[M].科学出版社,1996:245-246
39.秦兵芬.68例高位肛瘘术后从脾论治体会[J].四川中医,2001,19(12):60-61
40.谢国良.低位切开加五五丹引流治疗高位肛瘘60例[J].河北中医,2003,25(4):300-301
41.张平生.中西医结合治疗高位肛瘘181例[J].辽宁中医杂志,2001,28(9):552
42.黄乃健主编.中国肛肠病学.山东科学技术出版社,1994.753
43.郭荣.改良式切开挂线术配中药坐浴洗剂治疗高位肛瘘43例[J].陕西中医,2005,26(11):1183-1184
44.乔敬华.手术治疗669例肛瘘的体会[J].中华临床医药杂志,2005,16(10):41-43
45.栗军.高位挂线低位切开半开放改道引流治疗肛瘘[J].中华中西医杂志,2004,5(17):1917-1918
46.乔敬华.括约肌切断术式治疗肛瘘的体会[J].四川中医,2003,21(11):77-78
47.张宝庭.高位低缝治疗复杂性肛瘘180例[J].中国肛肠病杂志,2004,24(5):12-13
48.李敏.切开选择缝合术治疗高位复杂性肛瘘的临床研究[J].中国肛肠病杂志,2004,24(5):3-5
49.陆金根主编.大肠肛门病研究新进展[M].上海中医药大学出版社,2003:223-224. 外科杂志,2005,11(1):57-58
51.梁健民.切挂开窗引流术治疗高位复杂性肛瘘的临床研究[J].大肠肛门病外科杂志,2000,6(2):25-28
52.Deroide,-G.Fistulas et baeesde l' anus:asPectsdiagnosti ques et priciples therapuetiques,en dehors de la maladie de Crohn.J-Chir-(Paris).2000Apr;137(2):83-92
53.Hjortrup A,Moesgaard F et al.Fibrin adhesive in the treatment of perineal fistulas[J].Dis Colon rectum,1991,34:752-4
54.Abel ME,Chiu YS,Russell TR,et al.Autologous fibrin glue in the treatment of rectovaginal and complex fistulas[J].Dis Colon Rectum,1993,36:447-9
55.Cintron JR,ParkJJ,Orsay CP,et al.Repair of fistulas-in-anousing autologous fibrin tissue adhesive.Dis Colon Rectum[J].1999,42:607-613
56.Stephon M.Sentovich MD.Fibrin glue for anal fistula and long term results[J].Dis Colon Rectum,2003,46(4):498-502
57.Ian Lindsey,MM Smilgin-Humphreys,C Cunningham,et al.A randomized controlled trial of fibrin glue vs conventional treatment for anal fidtula[J].Dis Colon Rectum,2002,45(12):1608-1615
58.Sentocich SM.Dis Colon Rectum,2003,46(4):441-446
59.杨军,杨淼.福爱乐医用胶粘堵治疗肛瘘10例临床观察[J].临床外科杂志,2004,12(3):180
60.Venkatesh KS,Ramanujam P.Fibrin glue application in the treatment of recurrent anorectal fistulas[J].Dis Colon Rectum,1999,42:1136-1139
61.Cintron JR,Park JJ,Orsay CP,et al.Repair of Fistulas in ano using autologous fibrin tissue adhesive[J].Dis Colon Rectum,1999,42:607-13
62.Cintron JR,Park JJ,Orsay CP,et al.Repair of Fistulas in ano using fibrin adhesive[J].Dis Colon Rectum,2000,43:944-50
63.江厚象,王东,潘凯.分期手术并用纤维蛋白胶治疗复杂肛瘘的应用体会[J].大肠肛门病外科杂志,2004,10(1):58-59
64.K.M.CHAN,C.W.LAU,K.K.T.LAI,et al.Preliminary results of using a commercial fibrin sealant in the treatment of fistula-in-ano[J].JR Coll Surg Edinb,2002,47(1):407-10
65.Marc Singer,Jose Cintron,Richard Nelson,et al.Treatment of Fistulas-in-ano with Fibrin Sealant in Combination with Intra-adhesive Antibiotics and/or Surgical Closure of the Internal Fistula Opening[J].Diseases of the Colon & Rectum,2005,48(4):799-808
66.Rasmy Loungnarath,David W.Dietz,Matthew G.Mutch,Elisa H.Birnbaum,Ira J.Kodner,James W.Fleshmam.Dis Colon Rectum,2004,47(4):432-436
67.Oded Zmora,et al.Fibrin glue sealing in the treatment of perineal fistulas[J].Dis Colon Rectum,2003,46(5):584-589
68.刘承椿.介入放射法在治疗肛瘘中的应用[J].福建医药杂志,1999,21(5):61-62
69.王巧兮,任开明,李茂进.介入放射治疗肛瘘的临床研究[J].中国医学影像技术,1999,15(12):931-932
70.高峰,李文慧,印建国.介入治疗复杂性肛门直肠瘘5例报告[J].大肠肛门病外科杂志,2001,7(4):22-23
71.宋致辉,孙淑英,陈维萍,等.CO_2激光治疗肛瘘及肛裂[J].滨州医学院学报,2000,23(4):359
72.姚长虹.CO_2激光治疗肛瘘132例[J].中国激光医学杂志,2001,10(2):131
73.胡伯虎.大肠肛门病治疗学[M].北京:科技文献出版社,2001:352-353
74.朱建平,杨明忠.半开放缝合挂线术后治疗高位后蹄铁型肛瘘临床分析[J].航空航天医药,2003,4:21-22
75.陆一,安敏,赵自星.改进肛瘘切缝内口(挂线)引流术治疗马蹄形肛瘘的临床观察[J].成都中医药大学学报,2000,2:25-26
76.周恒.手术治疗后位马蹄型肛瘘的临床观察(附32例报告)[J].海南医学,2002,13(9):89-90
77.HANLEY PH.Dis Colon Rectum,1965,8:364
78.高野正博.外科治疗[M].1987:532
79.GOLIGHER JC.Surg of the Anus Rectum and Colon[M].4th ed.London:Balliere Tindal,1-1980
80.宇井本.…大肠肛门志,1982,35:305
81.黄明,张卫萍,陈斌武,等.低切高挂开窗留桥引流术治疗后位蹄铁型肛瘘63例[J].新疆中医药,2004,6:34-35
82.何德才,王惠君,商义.切开挂线皮桥旷置治疗马蹄型肛瘘临床疗效观察[J].川北医学院学报,2002,17(1):73-74
83.高见.开窗留桥拖挂术治疗马蹄型肛瘘[J].中国中西医结合外科杂志,2000,6121:127
84.李丽莉.150例蹄铁型肛瘘的治疗[J].现代医药卫生,2004,2:112
85.任锈稼.开窗留桥术治疗蹄铁型肛瘘186例临床观察[J].实用医技杂志,2004,15:67
86.黄伟.切开挂线隧道引流术治疗高位后蹄铁型肛瘘45例[J].黑龙江中医药,2004,1:29-30
87.杨勇军,唐学贵,李敏,等.切挂对口橡皮引流术治疗高位后马蹄型肛瘘临床观察[J].大肠肛门病外科杂志,2004,4:55-56
88.周立青,张效东,战晶涛,等.开窗搔刮挂线术治疗后马蹄型肛瘘43例[J].吉林医学,2005,26(2):220
89.张立军.外切内挂术治疗马蹄型肛瘘48例分析[J].郴州医学高等专科学校学报,2004,6(1):45
90.何春梅,曹永清,陆金根.隧道式拖线加内口切挂术治疗后位马蹄型肛瘘46例[J].上海中医药杂志,2004,38(6):32-33
91.赵自星,罗励,杨亚莎,等.高位后马蹄型肛瘘治疗方法的探讨[M].大肠肛门病研究新进展.上海:上海中医药大学出版社,2003:232-233
92.赵自星.实用肛瘘学[M].成都:四川科学技术出版社,2003
93.李平举,王云英等.红粉化腐膏及生肌散在肛瘘术后的应用[J].长春中医学院学报,2001,17(4):35
94.李美英,何昌国.自制祛腐生肌高促进肛瘘创面愈合的临床观察[J].中国中医药科技,2001,8(2):119-120
95.王爱华,李帅军,王真权等.银灰膏对肛瘘术后50例创面换药疗效观察[J].新中医,2003,35(4):21-22
96.封以生,张镇国.锡类散用于肛瘘术后换药的疗效分析[J].黑龙江中医药,2002:62
97.杨黎明.红油膏和三石粉用于肛瘘术后换药40例[J].湖南中医杂志,2003,19(1):45
98.龚德怡.痔科外洗方坐浴加快肛瘘术后创口愈合[J].天津中医药,2004,21(3):209
99.陈学玲.西瓜霜粉剂用户肛瘘术后换药的疗效观察[J].赫尔滨医药,2001,21(4):60
100.赵承竹.藻酸钙伤口敷料对肛瘘术后创面愈合作用的临床观察[J].上海医学,2003,26(6):321
100.孙建华,高凌卉.复方甲基纤维素促进肛瘘术后创面愈合的疗效分析[J].上海中医药杂志,2003,37(3):37
101.屈艳,胡英娥.贝复济促进肛瘘术后创面愈合的临床观察[J].江西医药,2004,39(6):464-465
102.卞守华,欧阳卫东.肛瘘588例诊治体会[J].内蒙古医学杂志,2004,36(3):212-214