瘘管剔除内口外移术联合富血小板血浆凝胶填充对肛瘘的临床疗效观察-现代医学

瘘管剔除内口外移术联合富血小板血浆凝胶填充对肛瘘的临床疗效观察

单位：1. 东南大学附属中大医院江北院区/南京市大厂医院肛肠科, 江苏南京 210048;
2. 南京市红十字医院肛肠科, 江苏南京 210001

分类号：R657.16

出版年·卷·期（页码）：2023·51·第八期（1104-1108）

摘要：

目的：评估瘘管剔除内口外移术联合富血小板血浆凝胶填充治疗肛瘘的疗效。方法：将24例肛瘘患者随机分为两组，治疗组11例，以瘘管剔除内口外移术联合富血小板血浆凝胶填充治疗；对照组13例，以肛瘘切除术治疗。术后对伤口疼痛情况、排尿情况、创面愈合情况、治愈率、治疗成功率及肛门功能进行比较。结果：术后首次排便时及术后第1、3、7天创面疼痛情况治疗组均较对照组明显减轻(均P＜0.05)；两组间排尿障碍情况及肛瘘治愈率对比均无显著差异(均P＞0.05)；治疗组创面愈合时间较对照组显著缩短(P＜0.01)；两组各有1例复发，治疗组和对照组的治疗成功率分别为72.73%和75.00%，两组间无显著差异(P＞0.05)；术后6个月时治疗组肛门功能Wexner评分较对照组明显降低(P＜0.05)。结论：瘘管剔除内口外移术联合富血小板血浆凝胶填充治疗肛瘘安全有效，且具有肛门功能损伤小、术后恢复快、患者痛苦轻的优点。

Objective: To evaluate the effect of fistulectomy with external sphincter preservation combined with platelet rich plasma filling in the treatment of anal fistula. Methods: 24 patients with anal fistula were randomly divided into two groups, 11 patients in the treatment group were treated with fistulectomy with external sphincter preservation combined with platelet rich plasma filling; 13 patients in the control group were treated with fistulectomy. The postoperative pain, urination disorders, wound healing time, curative effect, treatment success rate and anal sphincter function were compared between the two groups. Results: At the first postoperative defecation and on the 1st, 3rd, and 7th day after the operation, the wound pain in the treatment group was significantly reduced compared with the control group(P<0.05). There were no significant difference in postoperative urination disorders and the cure rate between the two groups(P>0.05). The wound healing time in the treatment group was significantly shorter than that in the control group(P<0.01). There was one recurrence in each group. The success rate was 72.73% in the treatment group, while 75.00% in the control group. There was no significant difference in the success rate between the two groups(P>0.05). At 6 months after the operation, the Wexner score in the treatment group was significantly lower than that in the control group(P<0.05). Conclusion: Fistulectomy with external sphincter preservation combined with platelet rich plasma fillingis an effective and safe treatment for anal fistula. It has the advantages of minimal damage to anal function, fast postoperative recovery and less pain.

参考文献：

[1] SOMMELING C E,HEYNEMAN A,HOEKSEMA H,et al.The use of platelet-rich plasma in plastic surgery:a systematic review[J].J Plast Reconstr Aesthet Surg,2013,66(3):301-311.
[2] JORGE J M,WEXNER S D.Etiology and management of fecal incontinence[J].Dis Colon Rectum,1993,36(1):77-97.
[3] 中国医师协会肛肠医师分会临床指南工作委员会.肛瘘诊治中国专家共识(2020版)[J].中华胃肠外科杂志,2020,23(12):1123-1130.
[4] MELZACK R.The McGill Pain Questionnaire:major properties and scoring methods[J].Pain,1975,1(3):277-299.
[5] VAN ONKELEN R S,GOSSELINK M P,SCHOUTEN W R.Treatment of anal fistulas with high intersphincteric extension[J].Dis Colon Rectum,2013,56(8):987-991.
[6] MCCOURTNEY J S,FINLAY I G.Setons in the surgical management of fistulainano[J].Br J Surg,1995,82(4):448-452.
[7] CHEW S S,ADAMS W J.Anal sphincter advancement flap for low transsphincteric anal fistula[J].Dis Colon Rectum,2007,50 (7)：1090-1093.
[8] GARG P.A new understanding of the principles in the management of complex anal fistula[J].Med Hypotheses,2019,132(11):109329.
[9] CIESLIK-BIELECKA A,DOHAN EHRENFEST D M,LUBK-OWSKA A,et al.Microbicidal properties of leukocyte-and platelet-rich plasma/fibrin (L-PRP/L-PRF):new perspectives[J].J Biol RegulHomeost Agents,2012,26(2 Suppl 1):S43-52.
[10] TEXTOR J.Platelet-rich plasma (PRP) as a therapeutic agent:platelet biology,growth factors and a review of the literature [M].Berlin:Springer,2014:61-94.
[11] TANG Y Q,YEAMAN M R,SELSTED M E.Antimicrobial peptides from human platelets[J].Infect Immun,2002,70 (12):6524-6533.
[12] TEMMERMAN A,CLEEREN G J,CASTRO A B,et al.L-PRF forincreasing the width of keratinized mucosa around implants:a split-mouth,randomized,controlled pilot clinical trial[J].J Periodontal Res,2018,53(5):793-800.
[13] NEIVA R F,GIL L F,TOVAR N,et al.The synergistic effect ofleukocyte platelet-rich fibrin and micrometer/nanometersurface texturing on bone healing around immediately placedimplants:an experimental study in dogs[J].Biomed ResInt,2016,2016(25):9507342-9507350.
[14] SERRAINO G F,DOMINIJANNI A,JIRITANO F,et al.platelet-rich plasma inside the sternotomy wound reduces the incidence of sternal wound infections[J].Int Wound J,2015,12 (3):260-264.
[15] CHEN Z.A study on the therapeutic effects of autologous platelet-rich plasma in the treatment of limbs refractory wound infection[J].Int J ClinExp Med,2017,10 (11):15316-15322.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录