网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
经括约肌间切开虚挂线术治疗高位复杂性肛瘘的临床研究
作者:高会妍  郑德  瞿胤  方臣阳  赵振华  杨敏  金兴涛  陈恺昕  陆宏 
单位:上海中医药大学附属曙光医院 肛肠科, 上海 200021
关键词:高位复杂性肛瘘 经括约肌间切开术 虚挂线疗法 切开挂线术 
分类号:R266
出版年·卷·期(页码):2024·52·第五期(744-748)
摘要:

目的:评价经括约肌间切开虚挂线术治疗高位复杂性肛瘘的疗效与安全性。方法:选取符合高位复杂性肛瘘诊断的80例患者,随机分为两组,每组40例。治疗组采用经括约肌间切开虚挂线术,对照组使用高位肛瘘挂线术。通过观察术后第1、7、14天肛门局部症状及创面愈合时间,评估术后肛门功能及临床疗效。结果:治疗组有效率明显高于对照组(P<0.05);与对照组相比,治疗组术后第1、7天出血、疼痛及肛门坠胀感明显较轻,术后第7、14天渗液明显较少;治疗组术后3、6个月Wexner肛门失禁评分均明显低于对照组,差异均有统计学意义(P<0.05);术后3、6个月随访治疗组最长收缩时间(ALCT)和肛管最大收缩压(AMCP)均明显高于对照组(P<0.05)。结论:经括约肌间切开虚挂线术治疗高位复杂性肛瘘疗效显著,术后并发症少,能较好地维护术后肛门功能。

Objective: To evaluate the efficacy and safety of transsphincteric fistulotomy combined with seton placement for the management of high complex anal fistulas. Methods: 80 patients diagnosed with high complex anal fistulas were randomly divided into two groups, with 40 patients in each group. The treatment group underwent transsphincteric fistulotomy combined with seton placement, while the control group received high ligation of anal fistula tract. The postoperative anal function and clinical efficacy were evaluated by observing local anal symptoms and wound healing time on the 1st, 7th, and 14th day after surgery. Results: The effective rate in the treatment group was significantly higher than that in the control group(P<0.05). Compared with the control group, the treatment group showed significantly less bleeding, pain, and sense of anal prolapse on the 1st and 7th day after sugery, and significantly less exudation on the 7th and 14th day after sugery. The Wexner incontinence scores of the treatment group at 3 and 6 months after sugery were significantly lower than those of the control group, indicating statistically significant differences(P<0.05). Furthermore, the anal longest contraction(ALCT) and the anal maximal contraction pressure(AMCP) of the treatment group were significantly higher than those of the control group at the 3 and 6-month postoperative follow-up(P<0.05). Conclusion: Transsphincteric fistulotomy combined with seton placement exhibits remarkable efficacy in the treatment of high complex anal fistulas, resulting in fewer postoperative complications and improved preservation of postoperative anal function.

参考文献:

[1] AMATO A,BOTTINI C,de NARDI P,et al.Evaluation and management of perianal abscess and anal fistula:SICCR position statement[J].Tech Coloproctol,2020,24(2):127-143.
[2] 张东铭.肛肠外科解剖生理学[M].西安:陕西科学技术出版社,1989.
[3] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
[4] JORGE J M,WEXNER S D.Etiology and management of fecal incontinence[J].Dis Colon Rectum,1993,36(1):77-97.
[5] WILLIAMS G,WILLIAMS A,TOZER P,et al.The treatment of anal fistula:second ACPGBI Position Statement-2018[J].Colorectal Dis,2018,20(3):5-31.
[6] 陶琦,陈利民.肛瘘挂线技术的研究进展[J].中国医学创新,2021,18(13):175-180.
[7] GÖTTGENS K W,SMEETS R R,STASSEN L P,et al.Systematic review and meta-analysis of surgical interventions for high cryptoglandular perianal fistula[J].Int J Colorectal Dis,2015,30(5):583-593.
[8] WALLIN U G,MELLGREN A F,MADOFF R D,et al.Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery?[J].Dis Colon Rectum,2012,55(11):1173-1178.
[9] SUN X L,WEN K,CHEN Y H,et al.Long-term outcomes and quality of life following ligation of the intersphincteric fistula tract for high transsphincteric fistulas[J].Colorectal Dis,2019,21(1):30-37.
[10] GARG P.Comparing existing classifications of fistula-in-ano in 440 operated patients:is it time for a new classification? A retrospective cohort study[J].Int J Surg,2017,42:34-40.
[11] GARG P.Transanal opening of intersphincteric space(TROPIS)-A new procedure to treat high complex anal fistula[J].Int J Surg,2017,40:130-134.
[12] 侯孝涛,陈浩,陈艳妮,等.经肛括约肌间切开术在治疗复杂性肛瘘中的应用[J].现代医学,2022,50(5):588-591.
[13] 李龑杼,周福荣,陈晓娟,等.Parks虚挂线术联合经肛门括约肌间切开术治疗高位复杂性肛瘘的疗效及预后分析[J].海军医学杂志,2022,43(12):1381-1383.
[14] 张燕,程一乘,王婧,等.高位肛瘘手术常见失败原因分析[J].中国临床医生杂志,2022,50(12):1477-1479.
[15] 李松辅,刘昆敏,高兴蓉,等.磁共振STIR序列联合T2WI压脂序列对肛瘘的诊断价值比较[J].现代医学,2020,48(4):492-496.

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
您是第 790205 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541