| 黄进,汪庆明,梅祖兵.经肛括约肌间切开术治疗复杂性肛瘘 32例[J].安徽医药,2023,27(8):1577-1581. |
| 经肛括约肌间切开术治疗复杂性肛瘘 32例 |
| Observation of clinical efficacy of transanal intersphincterotomy in the treatment of complex anal fistula |
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| DOI：10.3969/j.issn.1009-6469.2023.08.019 |
| 中文关键词: 直肠瘘 经肛括约肌间切开术 临床疗效 |
| 英文关键词: Rectal fistula Transanal intersphincterotomy Clinical efficacy |
| 基金项目:国家自然科学基金面上项目( 81774112) |
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| 中文摘要: |
| 目的观察经肛括约肌间切开术治疗复杂性肛瘘的临床疗效。方法收集 2021年 3―12月在上海曙光医院住院治疗的复杂性肛瘘病人 64例，采用随机数字表法分为观察组与对照组，每组各 32例，观察组采用经肛括约肌间切开术( TROPIS)，对照组行括约肌间瘘管结扎术( LIFT)。观察两组术前一般情况，术中记录不同术式，分别在术后 1、3、7d、2周、 3周、 1月、 3月观察病人疼痛、肛门 Wexner评分、创面肉芽肿生长情况、创面分泌物量等，评价两种术式的有效性及安全性。结果两组治疗后 3个月总有效率近 90%，观察组复发率为 9.4%，对照组为 22.0%，两组总有效率及复发率均差异无统计学意义( P>0.05)；两组术后 3d、1周、 3周、 1个月疼痛差值差异有统计学意义( P<0.05)；观察组术后创面愈合时间短于对照组，创面肉芽肿较对照组更平整，创面分泌物量少于对照组，均差异有统计学意义( P<0.05)；两组术后肛门 Wexner评分差异有统计学意义( P<0.05)，观察组术后 1月、 3月肛门失禁评分优于对照组。结论与 LIFT术相比， TROPIS术治疗复杂性肛瘘缩短了愈合时间、减少创面分泌物量，可以在有效切除内口以及感染肛腺的情况下，减少对病人肛门组织的损伤，对病人的肛门直肠环功能进行有效保护。 |
| 英文摘要: |
| Objective To observe the clinical effect of transanal intersphincterotomy in the treatment of complex anal fistula.Meth ods A total of 64 patients with complicated anal fistula who were hospitalized in Shanghai Shuguang Hospital from March to December 2021 were collected and randomly assigned into two groups, with 32 cases in each group. The observation group performed transanal intersphincterotomy (TROPIS), while the control group underwent intersphincteric fistula ligation (LIFT). The preoperative generalconditions of the two groups of patients were observed, and different surgical procedures were recorded during the operation. The pain,anal Wexner score, wound granuloma growth and wound secretion volume of patients were observed at 1 day, 3 days, 7 days, 2 weeks, 3weeks, 1 month, and 3 months after the operation to evaluate the efficacy and safety of the two surgical methods. Results Three months after treatment, the total effective rate of the two groups was nearly 90%, the recurrence rate of the observation group was 9.4%,and that of the control group was 22%. There was no significant difference in the total effective rate and recurrence rate between the twogroups (P>0.05). There were significant differences in pain difference between 3 days, 1 week, 3 weeks and 1 month after operation inthe group (P<0.05). The postoperative wound healing time of the observation group was shorter than that of the control group, the woundgranuloma was smoother than that of the control group, and the wound secretion volume was less than that of the control group, and thedifference was statistically significant (P<0.05); there was a statistically significant difference in the anal Wexner score between the two groups (P<0.05). The anal incontinence score at 1 month and 3 months after operation in the observation group was better than those inthe control group.Conclusions Compared with LIFT, TROPIS can shorten the healing time and reduce the amount of wound secretions in the treatment of complex anal fistula. It can reduce the damage to the patient's anal tissue under the condition of effective resection of the internal opening and infection of the anal glands. The patient's anorectal ring function can be effectively protected. |
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