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经肛括约肌间切开术改良挂线法与切开挂线术治疗高位肛瘘的效果

Effect of transanal opening of intersphincteric space modified thread-drawing method and incision thread-drawing surgery in treatment of high anal fistula

    摘要
  • 摘要:
    目的 探讨经肛括约肌间切开术(TROPIS)改良挂线法与切开挂线术对高位肛瘘的疗效及对疼痛指数、创面面积、肛门功能和术后并发症的影响。
    方法 选取88例高位肛瘘患者作为研究对象，随机分为对照组(44例，采用切开挂线术)和观察组(44例，采用TROPIS改良挂线法)。比较2组疗效、围术期指标、创面恢复、疼痛评分、肛门功能以及术后并发症发生情况。
    结果 治疗后，观察组临床总有效率高于对照组，差异有统计学意义(P < 0.05)。观察组创面愈合、便血、脓腐脱落、手术和住院时间短于对照组，创面瘢痕面积小于对照组，差异有统计学意义(P < 0.05)。治疗1、7 d后，观察组患者疼痛评分低于对照组，差异有统计学意义(P < 0.05)。观察组气体、液体、固体失禁和卫生垫使用及生活方式改变评分低于对照组，差异有统计学意义(P < 0.05)。观察组并发症总发生率低于对照组，差异有统计学意义(P < 0.05)。
    结论 与切开挂线术相比, TROPIS改良挂线法治疗高位肛瘘疗效确切，可减轻术后疼痛，改善患者肛门功能，且并发症发生风险较低。

     

    Abstract:
    Objective To investigate the efficacy of transanal opening of intersphincteric space (TROPIS) modified thread-drawing method and incision thread-drawing surgery in treatment of high anal fistula and its effects on pain index, wound area, anal function and postoperative complications.
    Methods A total of 88 patients with high anal fistula were selected as the research subjects. They were randomly divided into control group (44 cases, using incision thread-drawing surgery) and observation group (44 cases, using TROPIS modified thread-drawing method). The postoperative efficacy, perioperative indexes, wound recovery, pain index, anal function and postoperative complications were compared between the two groups.
    Results After treatment, the total clinical effective rate of the observation group was significantly higher than that of the control group (P < 0.05). Wound healing, hematochezia, pus shedding, operation and hospitalization time in the observation group were significantly smaller than those in the control group, and wound scar area was significantly smaller than that in the control group (P < 0.05). After 1 day and 7 days of treatment, the pain score of the observation group was significantly lower than that of the control group (P < 0.05). The scores of gas, liquid and solid incontinence, hygiene pad use and lifestyle change in the observation group were significantly lower than those in the control group (P < 0.05). The total complication rate of the observation group was significantly lower than that of the control group (P < 0.05).
    Conclusion Compared with incision thread-drawing surgery, TROPIS modified thread-drawing method is effective in treatment of high anal fistula, which can relieve postoperative pain and improve the anal function of patients, and the risk of complications is low.

     

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